???Flow-Through??? Type Free Flap for Revascularization and Simultaneous Coverage of a Nearly Complete Amputation of the Foot: Case Report and Literature Review

Tseng, Wen-Sun; Chen, Hung-Chi; Hung, James W.; Tasi, Tzong-Ru; Chen, Hern-Hsin; Wei, Fu‐Chan

doi:10.1097/00005373-200004000-00031

Cited by 18 publications

(8 citation statements)

References 12 publications

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“…27,31 Although free flaps can be used as flowthrough flaps for immediate revascularization and reconstruction, they are used mainly in traumatic settings where only a short vessel distance has to be bypassed. 32,33 None of the patients reported in our series was a candidate for this kind of reconstruction.…”

Section: Discussionmentioning

confidence: 84%

Combined Reconstruction of the Diabetic Foot Including Revascularization and Free-Tissue Transfer

Verhelle

Lemaire

Nelissen

et al. 2004

J reconstr Microsurg

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Diabetic patients, presenting with both peripheral vascular disease and large soft-tissue defects, are too often treated by primary amputation. A combined revascularization and free-tissue transfer procedure can extend limb salvage in these patients. The authors report their experience over 4 years with 19 diabetic patients with peripheral vascular disease and large soft-tissue defects of the foot requiring free-tissue transfer. Although there was a 100 percent flap survival, early local wound problems occurred in three patients (16.6 percent). The recurrence rate was about 18.7 percent, but no complementary flap procedures were mandatory. With a mean follow-up of 38 months (range: 23 to 55 months), the limb salvage rate was 94.4 percent. Although there was one limb loss and one patient with ambulation difficulties, 16 patients (84.2 percent) were fully rehabilitated and were able to function independently. Despite a rather small series, this study confirms that in selected diabetic patients, a combined approach of vascular and reconstructive surgeons can reduce the limb amputation rate with acceptable complication rates. This combined approach offers major benefits to these patients, especially stable coverage and preservation of ambulation, and should always be considered before amputation.

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Section: Discussionmentioning

confidence: 84%

Combined Reconstruction of the Diabetic Foot Including Revascularization and Free-Tissue Transfer

Verhelle

Lemaire

Nelissen

et al. 2004

J reconstr Microsurg

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“…7 Extremity replantation can also be established by a flow-through flap, as described by Tseng et al They used a radial forearm flow-through flap to replant and revascularize a nearly complete foot amputation. 8 Flow-through flaps have also been used for traumatic hand reconstruction. Libermanis et al 17 used retrograde radial forearm flaps for finger revascularization and soft tissue coverage, and Brandt et al 18 describe a series of 11 patients with complex hand injuries that were reconstructed using temporoparietal, dorsalis pedis, and fillet flow-through flaps.…”

Section: Applications Of Flow-through Flapsmentioning

confidence: 99%

“…Simultaneous transfer of vascularized bone graft or osteocutaneous flap together with forearm flap Hallock 12 Midfoot/Lower extremity peripheral vascular disease 1 Partial failure of radial forearm flap salvaged by using surviving portion as ' 'bridge' ' flap for revascularizing second free flap (gracilis) Kasten et al 13 Upper extremity trauma 1 Burt et al 62 Mid face trauma 1 Radial forearm flaps used in flow-through manner between gracilis flaps on each side and respective facial vasculature Tseng et al 8 Foot/Lower extremity trauma 1 Lateral antebrachial cutaneous n. Anastomosed to deep peroneal n. As sensate flap Libermanis et al 17 Hand trauma 2 Distally based, retrograde, radial forearm flaps for finger revascularization and soft tissue coverage Bacakoglu et al 1 Upper extremity trauma 2 Described treating delayed venous ischemia in flow-through flap using arteriovenous anastomosis Coban et al 10 Hand infection 1 Dorsal hand injury secondary to anthrax exposure Chun and Marin 9 Forefoot/Lower extremity peripheral vascular disease 2 Radial artery flow-through flap used as vascular conduit that provides venous outflow and acts as a functional modulated arteriovenous fistula Muneuchi et al 11 Lower extremity trauma 1 Radial forearm FTF used to restore soft tissue loss after replantation of leg Teodorescu et al 6 Lower extremity peripheral vascular disease 10 Composite femoral-tibial bypass graft constructed by sewing radial forearm graft to either greater saphenous vein or polytetrafluoroethylene graft Ulnar forearm Lovie et al 22 Defect in oral cavity, lower extremity, maxilla 11 Libermanis et al 17 Hand trauma 1 One-stage recon of two rays with soft-tissue defect and associated segmental defect of metacarpals and flexor tendons, nerves and arteries Posterior interosseous Shibata et al 24 Hand trauma 3…”

Section: Number Of Cases Commentsmentioning

confidence: 99%

“…Lower extremity donor flaps Anterolateral thigh (ALT) and anteromedial thigh (AMT) Koshima et al 30 Lower extremity peripheral vascular disease 8 Ao et al 26 Lower extremity trauma 5 Foot and tibial malunion Koshima et al 63 Head and neck neoplasm 2 Used as ' 'bridge' ' flap for radial forearm free flap Ao et al 27 Mandible/head and neck neoplasm 6 Combined anterior thigh flaps and vascularized fibular graft in bridge or chimeric fashion 20 Upper extremity iatrogenic 1 Radial arterial deficit from elevation of radial forearm free flap repaired using ALT flow-through flap Hsieh et al 28 Lower 64 Upper extremity trauma 1 High-energy induced injury to lower and upper limbs resulting from a land mine explosion, fillet flap from amputated leg Nisanci et al 32 Maxillofacial and Mandibular trauma 1 Massive maxillofacial destruction from a closerange, high-velocity gunshot injury Vascular toe-joint Koshima et al 37 Hand trauma 1 Segmental loss of amputated finger, Composite flap of proximal interphalangeal joint, plantar digital n., and tendons of toe Medial plantar Koshima et al 34 Hand trauma 1 Severe scar contracture resulting from steamburn injury on pulp aspect of right middle finger Wong et al 33 Hand trauma 3 Dorsalis pedis Brandt et al 18 Hand 40 Lower extremity 6 Ozkan et al 41 Lower extremity 1 Functional muscle transfer, ankle-joint active dosiflexion restored…”

Section: Defects Of Digits and Proximal Handmentioning

confidence: 99%

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Flow-through flaps: A review of current knowledge and a novel classification system

et al. 2006

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Flaps have long been recognized as an essential tool for soft-tissue reconstruction. Flaps range in complexity from local to free and perforator flaps and can include a variety of composite tissues. The concept of a flow-through flap, in which both the proximal and the distal ends of the vascular pedicle of a free flap are anastamosed to provide blood flow to distal tissues, was first described by Soutar et al. in 1983. An uninterrupted arterial flow was established by Soutar et al. between the external carotid and distal facial artery via a radial forearm flap for head and neck reconstruction (Soutar et al., Br J Plast Surg 1983;36:1-8). Shortly thereafter, Foucher et al. were the first to report the reconstruction of an extremity with a simultaneous vascular defect by utilizing a radial forearm flow-through flap (Foucher et al., Br J Plast Surg 1984;37:139-148). The utility of the flow-through flap is now well established, and its indications for use continue to grow. The principle advantage of this flap is that it provides the opportunity for a single stage composite reconstruction of both soft tissue and vascular defects, making it particularly useful in the reconstruction of ischemic extremities and defects from oncologic ablations. Improvements in microsurgical equipment and techniques are making early difficulties with these flaps irrelevant, giving plastic surgeons opportunities to become more creative in the choices and uses of flow-through flaps. The literature consists mostly of case reports and series. The nomenclature used to describe the types of flow-through flaps is confusing and inconsistent. The purpose of this article is to provide an organized review of flow-through flaps and to classify these flaps based on their inflow, outflow, and the nature of their vascular conduit. Additionally, we have included a discussion on the physiology of these flaps, reviewed the current literature, and summarized the various types of flow-through flaps in a reference guide that can aid in flap selection.

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“…[3][4][5][6][7][8] Flow-through flaps provide an opportunity for the simultaneous reconstruction of soft-tissue and vascular defects. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Based on these concepts, two-stage reconstructions with vascular grafs for revascularization and flap coverage for soft-tissue reconstruction in a second stage can be avoided. In this report, we describe, to the best of our knowledge for the first time, the functioning transfer of a muscle as a flowthrough type flap, to reconstruct a defect, in association with major vessels and extensor muscles in the lower extremity.…”

mentioning

confidence: 99%

Flow-Through, Functioning, Free Musculocutaneous Flap Transfer for Restoration of a Mangled Extremity

Özkan

Özgentaş²,

Dikici³

2005

J reconstr Microsurg

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Reconstructing a mangled extremity requires careful, complete examination of the functional and structural status of the injured part. Although the vascular status of the injured extremity is a priority, simultaneous reconstruction of skeletal, vascular, and neuromuscular structures should be considered in a combined approach. The purpose of this study was to describe a one-stage reconstruction of both soft-tissue coverage and revascularization for a lower extremity, along with functional restoration of an anterior lower leg. For this purpose, the functioning transfer of a free latissimus dorsi musculocutaneous flap as a flow-through type was performed. The results demonstrate that the technique is extremely useful in limb-salvage procedures from both functional and structural viewpoints.

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???Flow-Through??? Type Free Flap for Revascularization and Simultaneous Coverage of a Nearly Complete Amputation of the Foot: Case Report and Literature Review

Cited by 18 publications

References 12 publications

Combined Reconstruction of the Diabetic Foot Including Revascularization and Free-Tissue Transfer

Combined Reconstruction of the Diabetic Foot Including Revascularization and Free-Tissue Transfer

Flow-through flaps: A review of current knowledge and a novel classification system

Flow-Through, Functioning, Free Musculocutaneous Flap Transfer for Restoration of a Mangled Extremity

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