Fasciocutaneous Free Flaps Are More Reliable Than Muscle Free Flaps in Lower Limb Trauma Reconstruction: Experience in a Single Trauma Center

Sofiadellis, Foti; Liu, David S.; Webb, Angela; Macgill, Kirsty; Rozen, Warren M.; Ashton, Mark W.

doi:10.1055/s-0032-1313764

Cited by 42 publications

(62 citation statements)

References 25 publications

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“…Previously reported flaps used for local coverage of deep shoulder wounds following rotator cuff repair include the latissimus dorsa and pectorals major, both of which have been reported to have favourable outcomes [29][30][31]. Modern reconstructive literature indicates that utilization of well vascularized fasciocutaneous flaps is equivalent to use of a muscle flap for wound coverage, and the choice of the regional flap is at the discretion of the reconstructive surgeon [32][33][34][35][36].…”

Section: Resultsmentioning

confidence: 99%

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

Rl¹,

Kj²,

Nl³

et al. 2016

Bone Rep Recommendations

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Context: The treatment of rotator cuff tears has become one of the most common orthopaedic sports procedures. The development of a synovio-cutaneous fistula is a rare, but serious, complication that has been described after rotator cuff repair. The purpose of this report is to present the local rotational flap as a treatment option for synovio-cutaneous fistulas of the shoulder and to emphasize the importance of recognizing when primary closure may not be sufficient for adequate repair.Case Reports: A 67-year-old male who previously underwent a right rotator cuff and a biceps tendon repair presented with a persistently draining shoulder fistula. The decision was made to proceed with extensive debridement and closure using vascularized tissue. A 63-year-old male presented for a postoperative wound complication following attempted open debridement of a left torn rotator cuff. The wound was initially managed conservatively, but a persistently draining fistula necessitated the use of vascularized tissue for closure of the wound. The recovery of both patients was uneventful with no recurrent fistula formation. Both patients had improved shoulder range of motion following surgery and resolution of their pain. Conclusions:The excessive tension placed on the rotator cuff tendons and deltoid during repair and the resultant inflammation may contribute to tissue necrosis and facial dehiscence over the glen humeral joint, allowing for fistula formation. Surgeons should be aware that when adequate soft tissue coverage cannot be accomplished over the glen humeral joint via primary closure, there are local flaps available to provide complete coverage over the joint.

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Section: Resultsmentioning

confidence: 99%

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

Rl¹,

Kj²,

Nl³

et al. 2016

Bone Rep Recommendations

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“…8 The selection of appropriate recipient vessels is an essential element for achieving successful treatment outcomes in the reconstruction of lower extremity defects using free flap. 9 The anterior tibial artery is more vulnerable to damage compared with the posterior tibial artery.…”

Section: Discussionmentioning

confidence: 99%

The role of microvascular tissue transfer in severe limb trauma

et al. 2017

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Background: Lower extremity reconstruction is an essential part of plastic surgery and focuses on the treatment of wounds. The restoration of an intact covering is the primary surgical requisite following trauma of the lower extremity because deep healing can be no better than the surface covering. Present study will review the field of lower extremity reconstruction focusing on the micro-vascular tissue transfer for severe limb traumatic injuries.Methods: Patients were fully evaluated and defect was assessed depending on the defect requirement free micro- vascular flap was planned. 20 micro vascular flaps in 18 males and 2 females were used for the wound / defect of lower limbs following trauma.Results: There were 18 men and 2 women with a mean age of 43.6 years (range, 18-62 years) in the present study. The overall survival of the flaps was 95% (19/20).Conclusions: The free flap is an effective method of lower-extremity reconstruction. Good outcomes can be achieved with complete debridement and the selection of appropriate recipient vessels and flaps according to the recipient site.

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“…Lambourile liber transferate (lambouri fasciocutanate perforante, lambouri musculare) sunt frecvent utilizate pentru reconstrucţia posttraumatică a membrului pelvin [7]. Utilizarea unuia sau a celuilalt tip de lambou a rămas o problemă controversată în literatură [7].…”

Section: ) Lambourile Bazate Pe Extensorii Gambei (Tibial Anterior şunclassified

“…Utilizarea unuia sau a celuilalt tip de lambou a rămas o problemă controversată în literatură [7]. Scopul principal al microchirurgiei reconstructive este obţinerea unui rezultat estetic şi funcţional optim cu o morbiditate minimă a regiunii donatoare [8].…”

Section: ) Lambourile Bazate Pe Extensorii Gambei (Tibial Anterior şunclassified

“…Scopul principal al microchirurgiei reconstructive este obţinerea unui rezultat estetic şi funcţional optim cu o morbiditate minimă a regiunii donatoare [8]. Astfel, majoritatea articolelor retrospetive pledează pentru siguranţa mai mare a lambourilor libere fasciocutanate în reconstrucţia posttraumatică a membrului inferior [7,9], în timp ce alţii pledează pentru transferul liber de latissimus dorsi [10,11], cu o rată de supravieţuire a acestuia de 95%. Transferul liber microchirurgical presupune, însă: 1) o durată mare a intervenţiei datorită microanastomozelor vasculare, 2) necesitatea unei aparaturi de specialitate (microscop operator, instrumentar microchirurgical, material de sutură specific microanastomozelor) şi a personalului specializat şi antrenat cu aceste tehnici, 3) riscuri mai mari ale viabilităţii lambourilor şi 4) o rată de succes mai mică.…”

Section: ) Lambourile Bazate Pe Extensorii Gambei (Tibial Anterior şunclassified

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Coverage Techniques in a Crush Syndrome Case with Extended Soft-Tissue Defect of the Shank

Curic¹

2015

Surgery

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Case ReportOpen Access Keywords: Lower limb trauma; Crush syndrome; Soft-tissue defect;Muscle transposition flap IntroducereTraumatismele de strivire la nivelul extremităților, chiar dacă nu implică organele vitale, pot pune viaţa în pericol. "Crush syndrome" reprezintă manifestarea sistemică a distrugerii celulelor musculare şi eliberării conţinutului acestora în circulaţie, ducând la dereglarea metabolismului şi leziuni renale acute [1]. După reanimarea unui pacient cu o astfel de patologie, rămâne problema reconstrucţiei locale a defectului restant. Defectele de părţi moi cu expunere osoasă la nivelul gambei, în special cele pretibiale, rămân o provocare pentru chirurg, punând probleme în alegerea soluţiei chirurgicale optime de acoperire. Dificultatea este dată de mobilitatea redusă tegumentară a acestei regiuni şi de numărul redus de lambouri locoregionale (musculare, fasciocutanate) disponibile. De multe ori chirurgul este nevoit să apeleze la tehnici mult mai complexe de acoperire, cum ar fi lambourile perforante sau transferul liber microchirurgical [2]. Prezentare de cazPrezentăm cazul unui pacient F.I., 32 ani, fără antecedente heredocolaterale şi personale semnificative, fumător cronic, internat în regim de urgenţă, acesta fiind victima unui traumatism major prin strivire provocat de căderea unei greutăţi cu masa de 3 tone de la înălţimea de aproximativ 1 m pe gamba dreaptă a acestuia. Prezenţa sindromului de strivire ("crush syndrome") presupune instalarea în timp relativ scurt a devitalizării musculare şi edemului important al gambei însoţit de semne ale stării de şoc traumatic şi hemoragic, ceea ce impune tratarea pacientului în etape, de către o echipă mixtă alcătuită din medici de ATI, ortopezi şi chirurgi plasticieni.Prima etapă a fost reprezentată de primele 4 zile de internare ale pacientului în serviciul de ATI în vederea stabilizării hidroelectrolitice şi metabolice a acestuia şi prevenţia instalării complicaţiilor secundare stării de şoc. Examenul radiografic efectuat a evidenţiat prezenţa unei fracturi tip III C în 1/3 distală a gambei dreapte şi a unei fracturi de platou tibial extern drept. Examenul local al membrului pelvin drept a pus în evidenţă la inspecţie, după diminuarea edemului, atitudinea vicioasă a acestuia cu antepiciorul în varus, defect de părţi moi pe faţa anterointernă a gambei, cu expunerea marginii interne a tibialului anterior, a porţiunii externe a musculaturii din regiunea posterioară a gambei şi a tibiei pe toată lungimea sa cu vizualizarea focarului de fractură din 1/3 distală a gambei. Ţesuturile necrotice acopereau întreaga suprafaţă a defectului. S-a remarcat prezenţa multiplelor plăgi escoriate la nivelul regiunii posterioare a gambei şi coapsei, plagă transversală de 2 cm lungime la nivelul antepiciorului drept, sensibilitate normală şi puls prezent la pedioasă şi tibială posterioară. Mişcările din articulaţia genunchiului şi ale gleznei erau dureroase şi de amplitudine redusă. După reechilibrarea pacientului s-a intervenit chirurgical, practicându-se de către...

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Fasciocutaneous Free Flaps Are More Reliable Than Muscle Free Flaps in Lower Limb Trauma Reconstruction: Experience in a Single Trauma Center

Abstract: Statistically higher complication rates in key reliability markers were found in the M free flap group. This study found FC free flaps to be more reliable for reconstruction of lower limb injuries in a major trauma center.

Cited by 42 publications

References 25 publications

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

The Use of Regional Flaps for the Repair of Synovio-Cutaneous Fistulas of the Shoulder after Attempted Rotator Cuff Repair: A Report of Two Cases

The role of microvascular tissue transfer in severe limb trauma

Coverage Techniques in a Crush Syndrome Case with Extended Soft-Tissue Defect of the Shank

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