Lower limb reconstruction involving osteosynthesis material: A retrospective study on propeller flaps outcomes

Garcı́a-Dorado, David; Sapino, Gianluca; Schaffer, Clara; Borens, Olivier; Thein, E.; Bramhall, RJ; Summa, Pietro di

doi:10.1016/j.injury.2021.04.003

Cited by 7 publications

(11 citation statements)

References 19 publications

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“…The principal reason of no recurrence of infection was attributed to the vascularized induced membrane by cement spacer. As previous studies reported, the metalwork was a risk factor for the propeller flap (PPF) in soft tissue reconstruction (25). The failure of PPF and the underlying metalwork was believed to the poor blood supply of local soft-tissue bed, as the metal work interfere the original blood perfusion.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous reconstruction of septic composite defects in lower extremities: Combination of fasciocutaneous perforator flap and Masquelet technique

et al. 2022

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BackgroundManagement of composite defects with deep infection is a challenge to reconstructive surgeons. This study aimed to demonstrate the versatility, safety, and complications of simultaneous reconstruction of infectious composite defects with fasciocutaneous perforator flap combined with the Masquelet technique.MethodsThis study presents 10 patients in whom a fasciocutaneous perforator flap combined with the Masquelet technique was used to restore soft tissue and bone defects of the lower extremity, and were admitted in two level 1 trauma centers in Shanghai. The first stage included debridement of necrotic bone and infected tissues, implantation of a polymethylmethacrylate cement spacer to cover the void; bridging fixation of the osseous defect using external or internal fixators, and soft-tissue reconstruction with a fasciocutaneous perforator flap. The second stage included cement spacer removal with membrane preservation, refreshing bone edges, and grafting the cavity with bone morphogenetic proteins and autologous iliac bone graft.ResultsThe mean follow-up duration after autologous bone graft was 17.5 months. The average bony defects and average flap dimensions were 7.1 cm and 44.9 cm2, respectively. All flaps survived uneventfully. No recurrence of infection was detected in either the second stage of surgery or follow-up period. The mean duration of bone consolidation was 31.9 weeks. One patient had a 2 cm leg length discrepancy, and one patient had mild foot drop. No residual deformity requiring a secondary procedure occurred.ConclusionFasciocutaneous perforator flap combined with Masquelet technique provides a reliable and versatile alternative for patients with composite defects resulting from lower extremity infection.

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Section: Discussionmentioning

confidence: 99%

Simultaneous reconstruction of septic composite defects in lower extremities: Combination of fasciocutaneous perforator flap and Masquelet technique

et al. 2022

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“…Cases with >75% graft take were defined as healed, >50% but <75% graft take were considered partially healed (minor complication), while a nonhealing graft/failure was recorded in the case of <50% graft take or when secondary surgical procedures were needed in order to obtain the complete healing of the wound. Surgical complications were recorded according to previous literature [ 9 ]. Infection at the surgical site before and after the graft procedure was evaluated using microbiological samples and biopsy.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical indications for the use of NPTW are widening through the years and include, among others: open fractures with soft tissue defects, infected and chronic wounds, incisions at risk of breakdown and skin graft [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study

Sapino

Lanz

Roesti

et al. 2022

JCM

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Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation.

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“…Although simple and reliable pedicled gastrocnemius muscle flaps can be used for the reconstruction of the proximal part of the lower leg, it is often difficult to reconstruct the soft tissue defect using a pedicled flap from the middle third of lower leg to the foot because of the thin soft tissue and poor blood circulation [ 3 , 4 ]. Although various reconstruction procedures, such as the reverse sural arterial flap, perforator flap, and free flap (FF), have been reported for treating soft tissue defects from the middle third of the lower leg to the foot [ 5 – 8 ], the decision about the best procedure can be complicated by the risk that flap failure can lead to serious complications such as osteomyelitis and amputation when used for severe lower leg and foot injuries [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…The perforator-based propeller flap (PPF), as reported by Hyakusoku et al [ 11 ], has attracted recent interest as a new procedure for lower leg reconstruction due to its advantages such as avoiding the need for microsurgery, providing like-with-like cosmetic reconstruction effects, and shorter operation times [ 5 , 12 – 15 ]. However, flap congestion and partial necrosis at the tip of the flap are considered significant complications of PPF, and some surgeons have warned against its use for soft tissue defects caused by trauma [ 10 , 16 ]. Studies on reconstruction using PPF are sporadic, but many studies have included flaps not only for trauma but also for reconstruction after tumor resection [ 12 , 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

Ota,

Motomiya,

Watanabe

et al. 2024

BMC Musculoskelet Disord

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Background The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction. Methods We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis. Results The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases. Conclusions Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction. Data access statement The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Lower limb reconstruction involving osteosynthesis material: A retrospective study on propeller flaps outcomes

Cited by 7 publications

References 19 publications

Simultaneous reconstruction of septic composite defects in lower extremities: Combination of fasciocutaneous perforator flap and Masquelet technique

Simultaneous reconstruction of septic composite defects in lower extremities: Combination of fasciocutaneous perforator flap and Masquelet technique

One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study

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