Patient Height, Weight, BMI and Age as Predictors of Gracilis Muscle Free-Flap Mass in Lower Extremity Reconstruction

Oranges, Carlo M.; Tremp, Mathias; Wang, Wenjin; Madduri, Srinivas; Summa, Pietro G. di; Wettstein, Reto; Schaefer, Dirk J.; Kalbermatten, Daniel F.

doi:10.21873/invivo.11280

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…Magnetic resonance imaging (MRI) and computed tomographic scan showed inflammation of the distal tibia and osteopenia. To cover the soft-tissue defect, a free gracilis flap was performed using the secret scar technique ( Figure 5) (13,14). The external fixation was removed 11 weeks later and a nail-implantation inserted.…”

Section: Casementioning

confidence: 99%

Clostridial Infection After Open Fractures of the Lower Extremity – Report of Two Cases and Discussion of Pathomechanism and Treatment

Tremp¹,

Oranges²,

Majewski³

et al. 2019

In Vivo

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Background: Management of post-traumatic open fractures resulting from severe injuries of the lower extremity continues to challenge orthopedic and reconstructive surgeons. Moreover, post-traumatic osteoarticular infections due to Clostridium species are rare, with few reports in the literature. We describe possible pathomechanisms and propose treatment options for cases of delayed diagnosis of osteoarticular infections with Clostridium spp. Case Reports: Two patients sustained severe osteoarticular infection due to Clostridium spp. after open epi-and metaphyseal fractures of the lower extremity. In combination with radical debridement, ankle arthrodesis and long-term antibiotic treatment, satisfactory results were achieved after a followup of 18 months and 24 years. Conclusion: Clostridium species are difficult to identify, treatment is usually delayed and most patients have unfavourable outcomes. Although Clostridium species can be found regularly in posttraumatic wounds, post-traumatic osteoarticular infection due to Clostridium is rare. Approximately 20 cases have been reported in patients with open fractures, located mainly in the diaphyseal area (1-4). Clostridium species are found most often in fractures with severe environmental contamination of the wound during trauma (5). Clostridium species are anaerobic or occasionally aerotolerant gram-positive rods, found in soil, feces, sewage and marine sediments (6). They have the ability to form endospores, mainly under anaerobic conditions. These spores display high resistance to physical and chemical influences and are not sensitive to antibiotics. In addition, several Clostridium species have the ability to produce numerous protein toxins, causing necrotizing tissue destruction (7). Thus, bone marrow necrosis or necrotic bone fragments may occur (1, 8). The laboratory diagnosis of clostridial diseases depends on proper collection and handling of tissue samples (6). However, diagnosis is complicated by the fact that bone and joint infections due to Clostridium species are often polymicrobial (2). Although identification can be time-consuming, complete identification and testing of antimicrobial sensitivities have to be pursued. Species other than C. perfringens display a high variability in sensitivity testing, including to penicillin, cephalosporins, carbapenems and clindamycin (9). Once the strain has been identified, aggressive surgical treatment is mandatory (10). When in doubt, temporary or definitive external fixation should be preferred over internal fixation to allow repeated lavage if necessary (2). Wound excision and lavage without extensive bone tissue resection nearly always fails (2), probably due to persistence of spores in surrounding tissue. All the infected tissue must be excised and any internal fixation hardware removed (2). As a rule of thumb, Clostridium spp. complicating diaphyseal fractures cause extended bone loss due to necrosis. Reconstruction requires time-consuming segmental bone reconstruction, frequently combined with soft tissue ...

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Section: Casementioning

confidence: 99%

Clostridial Infection After Open Fractures of the Lower Extremity – Report of Two Cases and Discussion of Pathomechanism and Treatment

Tremp¹,

Oranges²,

Majewski³

et al. 2019

In Vivo

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“…The gracilis myocutaneous free flap is a workhorse muscle flap and a vital tool used in the reconstructive surgery armamentarium 1 . It has a wide array of applications ranging from autologous breast reconstruction, 2 restoration of elbow flexion following brachial plexus injury, 3–5 prevention of pharyngocutaneous fistula after total salvage laryngectomy, 6 and perineal, genital, and lower extremity reconstruction 7 . There exist several benefits of the gracilis muscle flap over other flap options, including relative ease of flap elevation and low donor-site morbidity 8 .…”

mentioning

confidence: 99%

“…1 It has a wide array of applications ranging from autologous breast reconstruction, 2 restoration of elbow flexion following brachial plexus injury, [3][4][5] prevention of pharyngocutaneous fistula after total salvage laryngectomy, 6 and perineal, genital, and lower extremity reconstruction. 7 There exist several benefits of the gracilis muscle flap over other flap options, including relative ease of flap elevation and low donor-site morbidity. 8 In addition, the gracilis itself is pliable and able to cover larger defects.…”

mentioning

confidence: 99%

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest

Donnelly,

Noh,

Silverman

et al. 2024

Ann Plast Surg

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Introduction The purpose of this study was to evaluate the role of body mass index (BMI) in predicting postoperative complications following myocutaneous free flap transfer. In addition, we sought to identify certain body composition variables that may be used to stratify patients into low- versus high-risk for gracilis myocutaneous free flap with skin paddle failure. Methods Using the National Surgical Quality Improvement Program database, we collected data for all patients who underwent myocutaneous free flap transfer from 2015 to 2021. Demographic data, medical history, surgical characteristics, and postoperative outcomes, including complications, reoperations, and readmissions, were collected. Body mass index was correlated with outcome measures to determine its role in predicting myocutaneous free flap reliability. Subsequently, we retrospectively obtained measurements of perigracilis anatomy in patients who underwent computed tomography angiography bilateral lower extremity scans with intravenous contrast at our institution. We compared body composition data with mathematical equations calculating the potential area along the skin of the thigh within which the gracilis perforator may be found. Results Across the United States, 1549 patients underwent myocutaneous free flap transfer over the 7-year study period. Being in obesity class III (BMI ≥40 kg/m2) was associated with a 4-times greater risk of flap complications necessitating a return to the operating room compared with being within the normal BMI range. In our computed tomography angiography analysis, average perigracilis adipose thickness was 18.3 ± 8.0 mm. Adipose thickness had a strong, positive exponential relationship with the area of skin within which the perforator may be found. Conclusions In our study, higher BMI was associated with decreased myocutaneous free flap reliability. Specifically, inner thigh adipose thickness can be used to estimate the area along the skin within which the gracilis perforator may be found. This variable, along with BMI, can be used to identify patients who are considered high-risk for flap failure and who may benefit from additional postoperative monitoring, such as the use of a color flow Doppler probe and more frequent and prolonged skin paddle monitoring.

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Skeletal muscle indices for healthy Indians

Bhargava¹,

Garg²,

Singh

et al. 2023

Indian J Gastroenterol

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Patient Height, Weight, BMI and Age as Predictors of Gracilis Muscle Free-Flap Mass in Lower Extremity Reconstruction

Abstract: In our series, the mass of the gracilis muscle flap was predictable in relation to height, weight, BMI, and age, which can be considered reliable proxy measurements. This will contribute to adequate flap selection for microsurgical reconstruction of lower extremity defects.

Cited by 4 publications

References 23 publications

Clostridial Infection After Open Fractures of the Lower Extremity – Report of Two Cases and Discussion of Pathomechanism and Treatment

Clostridial Infection After Open Fractures of the Lower Extremity – Report of Two Cases and Discussion of Pathomechanism and Treatment

Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest

Skeletal muscle indices for healthy Indians

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