Limb Salvage Using Combined Linking Perforator Free Flaps

Kim, Youn Hwan; Kim, Gyeong Hoe; Pafitanis, Georgios; Miller, Rob; Kim, Sang Wha

doi:10.1177/1534734619864240

Cited by 5 publications

(2 citation statements)

References 31 publications

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“…Moreover, strategies should be used to reduce donor site complications. With improved reconstructive methods, chimeric, sequential, and combined perforator flap transplantations are ideal methods to repair large wounds, with minimal donor site morbidities 1 , 2 , 3 . However, additional microsurgical anastomosis was more time‐consuming and technically demanding, increasing surgical complexity.…”

Section: Introductionmentioning

confidence: 99%

Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity

Qing

et al. 2022

Orthopaedic Surgery

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The aim of the present study was to report a novel nomenclature system for extended latissimus dorsi musculocutaneous (LD) flaps. To evaluate the clinical application and surgical efficacy of the different extended LD flaps for large wounds in the extremities.Methods: From January 2004 to December 2018, 72 consecutive patients who received extended LD flaps were retrospectively analyzed. Patients' ages ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 cm Â 10 cm to 37 cm Â 21 cm. Forty-one wounds were located in the calf, 18 in the foot and ankle, six in the shoulder and upper arm, four in the thigh, and three at the knee joint. Twenty-eight patients had fractures, and six of these patients with segmental bone defects (ranging in size from 3 to 7 cm) required secondary orthopaedic procedures. Single-and double-wing extended LD flaps were designed and harvested according to the shape of the wounds. Results:The flaps received consisted of 64 single-wing and eight double-wing extended LD flaps, and the mean flap harvest time was 56.2 min. The donor sites were closed primarily for all patients. Additional subcutaneous veins were anastomosed to the recipient's vessels in 14 patients. The venous crisis was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re-exploration, and another two patients' flaps were necrosed. In these two patients, lower limb amputation and extended LD flap on the other side were used, respectively, for the final treatment. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Six patients had segmental bone defects that required secondary orthopaedic procedures, two patients were repaired with vascularized iliac crest bone grafts, and another four patients were reconstructed by the Ilizarov technique. All the patients' bone defects achieved union and most patients achieved good functional recovery at the recipient site. The mean follow-up was 15.7 months (range, 10-56 months). No significant donor site morbidities limiting patients' daily activities occurred during the follow-up. Eight patients developed a donor site hypertrophic scar, three patients on the back, and five on the anterolateral thigh. Conclusion:Single-and double-wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity, with good functional and aesthetic results.

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Section: Introductionmentioning

confidence: 99%

Variations of Extended Latissimus Dorsi Musculocutaneous Flap for Reconstruction of Large Wounds in the Extremity

Qing

et al. 2022

Orthopaedic Surgery

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“…Moreover, Kim et al 5 examine how limb salvage can be improved by combined linking perforator free flaps. In lower limb orthopedic surgery, postoperative deep vein thrombosis may be linked with serum lipids, as reported by Dai et al 6 In patients with critical limb ischemia undergoing revascularization, hyperbaric oxygen therapy is shown to improve peripheral circulation.…”

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confidence: 99%

A Wealth of Science

Παπάνας

Papi²

2020

The International Journal of Lower Extremity Wounds

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This is the first issue of 2020 and full with a wealth of science. Srivastava and Sivashanmugam 1 discuss drug combinations to heal Pseudomonas infections in diabetic foot ulcers. Brookes et al 2 have shown that nutritional deficiencies may predict diabetic foot amputations. Relevant to amputations, Papadokostaki et al 3 provide a review of amputation risk associated with the antidiabetic drug canagliflozin. Salutini et al 4 conducted a survey among Italian experts to achieve a consensus on diabetic foot management. Moreover, Kim et al 5 examine how limb salvage can be improved by combined linking perforator free flaps. In lower limb orthopedic surgery, postoperative deep vein thrombosis may be linked with serum lipids, as reported by Dai et al. 6 In patients with critical limb ischemia undergoing revascularization, hyperbaric oxygen therapy is shown to improve peripheral circulation. 7 In chronic venous leg ulcers, improvements with peri-ulcer foam sclerotherapy are reported by Kamhawy et al. 8 In lower limb reconstructive surgery, new experience with perforatorbased propeller flaps is reported by Shahabuddin and Khurram. 9 Exposed foot tendons may be better covered by a new human-derived acellular dermal matrix, as shown by Melandri et al. 10 Finally, some interesting case reports 11-13 enrich our knowledge on wound healing: a wealth of science, to which our journal is dedicated. 14,15 Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. 6. Dai X, Ding W, Li H, et al. Associations of serum lipids and deep venous thrombosis risk after total knee arthroplasty in patients with primary knee osteoarthritis.

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