Evaluation of Late Functional Results of Patients Treated with Free Muscle Flaps for Heel Defects Caused by Land-Mine Explosions

Öztürk, Serdar; Bayram, Yalcin; Möhür, Haydar; Deveci̇, Mustafa; Şengezer, Mustafa

doi:10.1097/01.prs.0000189202.50629.a3

Cited by 27 publications

(10 citation statements)

References 13 publications

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“…Higher rates of vascular revisions were observed in MF in the immediate postoperative period. One study 28 in our analysis which described MF ( n = 72, 53%) for severe land mine injuries reported the highest number of vascular revisions (9.7%). Land mine injuries generally result in composite tissue defects with extensive soft tissue damage which might account for the higher rates of vascular emergencies in MF.…”

Section: Discussionmentioning

confidence: 76%

“…Studies included 14 prospective and 6 retrospective cohorts. Ten articles 16 17 18 19 20 21 22 23 24 25 reported on FCF reconstruction, three 26 27 28 included MF, and seven 1 29 30 31 32 33 34 compared both flaps ( Table 1 ). The 20 included studies encompassed 255 patients with a mean follow-up of 2.79 ± 1.52 years.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies 16 17 18 19 20 21 23 24 25 26 27 28 30 report revision procedures in the immediate postoperative period. Anastomotic revisions were higher in MF (10.5%) compared with FCF (6.3%).…”

Section: Resultsmentioning

confidence: 99%

“…Time to weight bear on the reconstructed heels varied from 4 weeks to 3 months. 1 26 27 28 30 33 Standardized mean difference with inverse-variance approach was –3.03 (95% CI, –4.25, –1.80, p < 0.00001) suggesting that time to bear weight and subsequent return to daily activities were earlier with FCF compared with MF ( Supplementary Fig. S2 , online only).…”

Section: Resultsmentioning

confidence: 99%

“…32 In MF reinnervation was done either by coaptation of recipient nerve to motor nerve of the muscle or an onlay nerve graft between the muscle and skin graft. 31,32 Thirteen studies [16][17][18][19][20][21][23][24][25][26][27][28]30 report revision procedures in the immediate postoperative period. Anastomotic revisions were higher in MF (10.5%) compared with FCF (6.3%).…”

Section: Surgical Characteristicsmentioning

confidence: 99%

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Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case Series

Chellamuthu

Jayaraman

Ramesh

2023

Indian J Plast Surg

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Background Choosing the components of free flap (fasciocutaneous or muscle) is one of the crucial but controversial decisions in heel reconstruction. This meta-analysis aims to provide an up-to-date comparison of fasciocutaneous flaps (FCFs) and muscle flaps (MFs) for heel reconstruction and to ascertain if one flap has an advantage over the other. Methods Following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed identifying studies on heel reconstruction with FCF and MF. Primary outcomes were survival, time of ambulation, sensation, ulceration, gait, need for specialized footwear, revision procedures, and shear. Meta-analyses and Trial Sequential Analysis (TSA) were performed to estimate the pooled risk ratios (RRs) and standardized mean difference (SMD) with fixed effects and random effects models, respectively. Results Of 757 publications identified, 20 were reviewed including 255 patients with 263 free flaps. The meta-analysis showed no statistically significant difference between MF and FCF in terms of survival (RR, 1; 95% confidence interval [CI], 0.83, 1.21), gait abnormality (RR, 0.55; 95% CI, 0.19, 1.59), ulcerations (RR, 0.65; 95% CI, 0.27, 1.54), footwear modification (RR, 0.52; 95% CI, 0.26, 1.09), and revision procedures (RR, 1.67; 95% CI, 0.84, 3.32). FCF had superior perception of deep pressure (RR, 1.99; 95% CI, 1.32, 3.00), light touch, and pain (RR, 5.17; 95% CI, 2.02, 13.22) compared with MF. Time to full weight-bearing (SMD, –3.03; 95% CI, –4.25, –1.80) was longer for MF compared with FCF. TSA showed inconclusive results for comparison of the survival of flaps, gait assessment, and rates of ulceration. Conclusion Patients reconstructed with FCF had superior sensory recovery and early weight bearing on their reconstructed heels, hence faster return to daily activities compared with MFs. In terms of other outcomes such as footwear modification and revision procedure, both flaps had no statistically significant difference. The results were inconclusive regarding the survival of flaps, gait assessment, and rates of ulceration. Future studies are required to investigate the role of shear on the stability of the reconstructed heels.

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Section: Discussionmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Surgical Characteristicsmentioning

confidence: 99%

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Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case Series

Chellamuthu

Jayaraman

Ramesh

2023

Indian J Plast Surg

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The use of fabricated chimeric flap for reconstruction of extensive foot defects

et al. 2015

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Repair of extensive foot defects requires both adequate tissues for wound coverage and special tissues for functional reconstruction. To maximize its function reconstruction, fabricated chimeric flaps consisting of multiple separate flaps were designed to reconstruct such defects. Five patients suffered extensive foot defects with sizes ranging from 23 × 12 cm to 38 × 14 cm(2) in multiple regions including heel, forefoot, dorsum, ankle, anterior leg, and even toes. Causes included crushing injuries, avulsion injuries, and scar excision. Most areas of the defects except heel were first covered by latissimus dorsi muscle flap or anterolateral thigh flap and their pedicles were anastomosed with recipient vessels. Then free medial plantar flaps were transferred for heel reconstruction and their pedicles were further attached to either side branches of the main source vessel or to its distal continuation. All chimeric flaps survived uneventfully and all patients were able to walk in normal footwear during the 1.5- to 4-years follow-up. None of the flaps developed ulcer and flap breakdown. The assessment by Maryland Foot Score showed that four of the five patients gained a "good" recovery and one patient showed moderate improvement of foot functions. Appearances of reconstructed heels were near-normal. The results indicate that fabricated chimeric flap has good design flexibility and may provide an option for functional reconstruction of extensive foot defects. © 2015 Wiley Periodicals, Inc. Microsurgery 36:303-309, 2016.

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Evaluation of 389 patients following free‐flap lower extremity reconstruction with respect to secondary refinement procedures

et al. 2017

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Evaluation of Late Functional Results of Patients Treated with Free Muscle Flaps for Heel Defects Caused by Land-Mine Explosions

Abstract: This is the longest series documenting the long-term functional results of patients injured by land mines who were treated with free muscle flaps. Reconstructive options should be preferred to amputation procedures in extensive tissue loss caused by land-mine explosion where possible.

Cited by 27 publications

References 13 publications

Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case Series

Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case Series

The use of fabricated chimeric flap for reconstruction of extensive foot defects

Evaluation of 389 patients following free‐flap lower extremity reconstruction with respect to secondary refinement procedures

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