Distally Based Fasciocutaneous Flap of the Calf for Cutaneous Coverage of the Lower Leg and Dorsum of the Foot

Almeida, Otavio Machado de; Monteiro, Aílton Rocha; Neves, Rogério I.; Lemos, Ricardo Gomes de; Braz, Jorge Caio; Brechtbühl, Eduard René; Gemperli, Rolf; Ferreira, Marcus Castro

doi:10.1097/00000637-200044040-00003

Cited by 31 publications

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“…O terço inferior da perna, especificamente, é um local de estruturas com função dinâmica (tendões e articulação do tornozelo) e os retalhos menos espessos, com fibrose menor e, portanto, com mais elasticidade, permitem um resultado funcional e estético melhor em áreas doadoras e receptoras 7 aumento na sua indicação para cobertura, sobretudo nas regiões distais do membro inferior 8,9 . Em 1991, Hyakusoku descreve o retalho em hélice, o propeller flap, que pode ser rodado em 180º, tendo como base a perfurante como seu eixo 10 .…”

Section: Discussionunclassified

“…Este problema com a rotação não ocorre nos retalhos perfurantes em hélice assimétrica (propeller flaps), pois têm como ponto de rotação somente os vasos, que permitem sua rotação até 180º e uma parte da área doadora é coberta pelo componente menor da hélice 22 . O uso de retalhos de pedículo distal em ilha, utilizando-se de seu pedículo das artérias do plexo supramaleolar, liberando e seccionando o septo proximalmente, permite a transposição do retalho, sem aumento de seu comprimento (o que ocorre mesmo nos propeller flaps), alcançando áreas mais distais, sem aumentar a extensão da área doadora, melhorando o resultado estético 9 , sem preocupação com lesões de vasos e nervos importantes.…”

Section: Conclusãounclassified

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Retalho supramaleolar de fluxo reverso: aplicações clínicas

Batista

2011

Rev. Bras. Cir. Plást. (Impr.)

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RESUMOAs regiões distais do membro inferior, incluindo o terço inferior da perna e os pés, são áreas muito propensas a perda de partes moles por trauma e lesões tróficas. A posição anterior da tíbia, com sua cobertura pouco espessa e vulnerável, além da grande quantidade de tendões, que não podem permanecer expostos, exigem uma cobertura cutânea rápida e, ao mesmo tempo, complexa. A situação em relação à direção do fluxo sanguíneo, a escassez de ventres musculares para retalhos e pele pouco elástica para retalhos randomizados viá-veis complicam esta situação. No passado, retalhos com transferência intermediária foram utilizados; assim como os de perna cruzada, "cross leg", ainda são, com desvantagens importantes: dependem de mais de um tempo cirúrgico, geram muito desconforto ao paciente e nem sempre são eficazes. A microcirurgia tornou-se uma opção que contribui muito para cobertura de lesões neste aspecto, porém, depende de equipe com treinamento e material especializado. As áreas doadoras são maiores, podem causar relativo déficit funcional e utilizam troncos vasculares maiores. Os retalhos fasciocutâneos de fluxo reverso podem contribuir para a cobertura de lesões pequenas e médias nesta localização, com sequelas funcionais e estéticas menores; e menor tempo cirúrgico. Constitui eficiente opção cirúrgica por sua facilidade, segurança e versatilidade. Neste estudo, temos o objetivo demonstrar o retalho supramaleolar de fluxo reverso utilizado em 4 casos, com aplicações em situações diferentes, com resultados satisfatórios de fácil execução e reprodução.Descritores: Retalhos cirúrgicos. Traumatismos da perna. Traumatismos do tornozelo. Extremidade inferior/cirurgia. ABSTRACTThe regions of the distal lower limb, including the 1/3 lower leg and foot areas are very prone to loss of soft tissue for trauma and ulcerations. The anterior position of the tibia, with its coverage slightly thick and vulnerable, besides the large amount of tendons, which can not remain exposed, requiring skin coverage quickly and simultaneously complex. The situation with respect to the direction of blood flow, lack of muscle bellies for flaps and skin flaps for inelastic randomized viable complicates this situation. In the past, with intermediate transfer flaps were used, as the leg cross, are still with major drawbacks: they rely on more than one occasion, generate a lot of discomfort to the patient and are not always effective. Microsurgery has become an option that helps a lot to cover injuries this point, however, depends on the team with training and specialized equipment. Donor areas are larger, can cause functional impairment and use on major vascular trunks. The fasciocutaneous flaps of reverse flow can contribute to the coverage of small and medium lesions in this location, with minor aesthetic damage and functional and less time for surgery. It constitutes effective surgical option for its ease, safety and versatility. In this study we demonstrate supramalleolous flap of reverse flow used in 4 cases, with applications in diffe...

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Section: Discussionunclassified

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Retalho supramaleolar de fluxo reverso: aplicações clínicas

Batista

2011

Rev. Bras. Cir. Plást. (Impr.)

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“…3 Many authors have recommended distally-based fasciocutaneous flaps to obtain cover of distal defects in the lower limb. [18][19][20][21][22][23][24][25] In an effort to reduce complications, we have used the principle of a distally-based fasciocutaneous flap for the surgical approach to tendo Achillis. An incision adjacent to the tendon is avoided and wide exposure is achieved.…”

Section: Discussionmentioning

confidence: 99%

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

Chana

Chen

Jain

2002

The Journal of Bone and Joint Surgery. British volume

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he consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avoids making an incision directly over the tendon, provides good exposure, and maintains the vascularity of the skin overlying the tendon. The current, preferred surgical approach to tendo Achillis is a longitudinal incision, either on its medial or lateral side. 1,2 There is, however, a risk of breakdown of the wound because of poor vascularity of the skin in this region. As it heals the tendon lies directly beneath the incision. The potential complication is skin loss with exposure and necrosis of the tendon. We describe an approach to tendo Achillis which uses the principle of a distally-based fasciocutaneous flap in order to avoid making an incision too close to the tendon. Patients and MethodsOperative technique. A distally-based fasciocutaneous flap is raised with the vertical limbs just posterior to each malleolus. The transverse limb is made above the tendinous portion of gastrocnemius (Fig. 1). Since this is a randompattern fasciocutaneous flap, the ratio of the length to width is kept to a maximum of 3:1.3 The flap is raised in the subfascial plane in order to achieve exposure of the tendon (Fig. 2). On the lateral side, care must be taken to ensure T that the sural nerve is not damaged. Closure of the skin is achieved using 4-0 vicryl subcuticular dermal sutures with the knots buried and 4-0 nylon for the skin. In tendonlengthening procedures with a chronic plantar flexion deformity, deficiency of skin may require either a full-thickness graft from the groin, or a split-thickness graft from the thigh (Fig. 3). Illustrative case reportsCase 1. A 51-year-old man presented with a rupture of the right tendo Achillis sustained while playing basketball one week earlier. He underwent surgery using a distally-based fasciocutaneous flap and the tendon was repaired with 2/0 prolene. He had an uneventful postoperative recovery. At the follow-up at six months he was fully mobile, although he had a slightly hypertrophic scar at the medial malleolus. Case 2. A 45-year-old man presented with a rupture of his left tendo Achillis which he had sustained one month earlier.He underwent surgery using a distally-based fasciocutaneous flap and the tendon was repaired with 2/0 prolene. His postoperative recovery was uneventful. Seven months after surgery the scar had healed and he was walking normally. Case 3. A 25-year-old man had suffered a crush injury to his right foot and ankle ten years earlier which had remained untreated. He presented with a plantar flexion deformity of his right foot and was only able to walk on tiptoe. Examination revealed a shortened and contracted tendo Achillis. Radiographs revealed no bony abnormality. He underwent surgery to lengthen the tendon. An inci...

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“…This allows much greater area of skin to be transferred with much more freedom of leg position 12. The flap provided stable coverage for different defects with few complications 3. Even should the flap fail, no significant bridges have been burnt and all the other surgical options remain viable.…”

Section: Introductionmentioning

confidence: 99%

Cross-leg flap: Its role in limb salvage

Agarwal

Raza

2008

Indian J Orthop

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Background:Pedicled cross-extremity flaps for lower limb wound coverage have been replaced by free tissue transfer in the last two decades. However, there are certain difficult situations where the free flap cannot be employed and alternative methods are needed. We describe our experience with cross-leg flap in 18 patients for the reconstruction of difficult leg defects in which no suitable recipient vessels were available for microvascular anastomosis in the vicinity of the defect.Materials and Methods:18 patients (17 men and 1 woman) with mean range 31.5 yrs(range 18-70 yrs) grade III B tibial fractures were included in the study. fasciocuteneous cross leg flap was employed and extremities were immobilized by external Fixator.Results:Fifteen flaps were completely available with two had marginal necrosis and one supsficial epidermal necrosis. No complications were related to the donor site, flap, or by immobilization are noted. Each patient resumed essentially normal gait and activity without any stiffness of joints related with the flap or external fixator.Conclusion:The addition of external fixator stabilization aids greatly in wound care, as well as for general ease of the patient mobility and positioning. Cross-leg flap offers the possibility of salvaging limbs that are otherwise nonreconstructable.

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Distally Based Fasciocutaneous Flap of the Calf for Cutaneous Coverage of the Lower Leg and Dorsum of the Foot

Cited by 31 publications

References 0 publications

Retalho supramaleolar de fluxo reverso: aplicações clínicas

Retalho supramaleolar de fluxo reverso: aplicações clínicas

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

Cross-leg flap: Its role in limb salvage

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