Postoperative negative pressure therapy significantly reduces flap complications in distally based peroneus brevis flaps: Experiences from 74 cases

Erne, H.; Schmauß, Daniel; Schmauss, Verena; Ehrl, Denis

doi:10.1016/j.injury.2016.02.017

Cited by 9 publications

(8 citation statements)

References 18 publications

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“…In addition to the short operating time, the short postoperative inpatient stay of only 11 days should also be pointed out, which is highly relevant clinically, especially in the multimorbid patients, often prone to immobility, studied here. Some authors have characterized DPBM flap surgery as unsafe due to a high complication rate 29 , 30 , 35 , 36 . Barr et al in particular report a necrosis rate of the distal third of the flap of 100%, although they only operated on 4 patients 29 .…”

Section: Discussionmentioning

confidence: 99%

Distally Based Peroneus Brevis Muscle Flap for Lower Extremity Defect Reconstruction in Severely Ill Multimorbid Patients

et al. 2021

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Background Reconstruction of lower extremity soft tissue defects is an exceptional surgical challenge, especially in multimorbid, elderly and severely ill patients with their thin and tense local soft-tissue conditions and increased perioperative risk. The distally based peroneus brevis muscle flap (DPBM), a local flap based on the muscular branches of the fibular artery, could pose a pragmatic solution. The objective of this study was to evaluate and quantify DPBM defect reconstruction in the lower leg, especially in elderly, multimorbid and severely ill patients. Material and Methods The DPBM as a surgical option in defect reconstruction in multimorbid, elderly, severely ill patients (inclusion criteria: at least 3 pre-existing comorbidities, patient age: at least 55 years, ASA status: at least III) was evaluated in a retrospective single-centre study from 01 April 2014 to 31 December 2019. The electronic SAP health records (EHR) were analysed according to 18 criteria, including patient details, extent of multimorbidity, defect characteristics, clinical outcome, and complications. Outcome Ten patients with a mean age of 72.6 years, a mean number of 8.5 pre-existing comorbidities and a mean ASA status of 3.1 met the inclusion criteria. The leading causes of defects, each with exposed tendons, bones, joint capsule, or joint, were chronic ulcers (n = 5) and soft tissue defects resulting from fractures (n = 3). In case of DMPB the success rate was 100% (no partial or total loss) with a short operating time (mean: 103 min) and a brief postoperative length of stay (mean: 11 d). In 2 patients (20%), DPBM surgery had to be discontinued intraoperatively and an alternative technique of defect reconstruction had to be adopted. The reasons included impaired muscle perfusion and fatty degeneration of the peroneus brevis muscle. Conclusion The DPBM flap allows straightforward, fast and safe defect reconstruction in the lower extremity, particularly in elderly, multimorbid and severely ill patients at risk. In patients with inadequate peroneal brevis muscle, however, DMPB surgery should be discontinued intraoperatively and the defect reconstructed using alternative techniques.

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Section: Discussionmentioning

confidence: 99%

Distally Based Peroneus Brevis Muscle Flap for Lower Extremity Defect Reconstruction in Severely Ill Multimorbid Patients

et al. 2021

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“… 6 Delayed grafting and application of negative pressure therapy postoperatively are other methods to avoid graft loss. 20 Abd-Al Moktader 21 , 22 described open book splitting of distally based peroneus brevis muscle flap to cover moderate to large size defects (up to 120 cm 2 area. Barbera et al.…”

Section: Discussionmentioning

confidence: 99%

“…To avoid graft loss, one has to achieve adequate hemostasis and position the flap with the true muscle tissue facing outwards the skin graft, rather than the tendinous part, as suggested by Bajantri et al 6 . Delayed grafting and application of negative pressure therapy postoperatively are other methods to avoid graft loss 20 . Abd-Al Moktader21, 22 described open book splitting of distally based peroneus brevis muscle flap to cover moderate to large size defects (up to 120 cm 2 area.…”

Section: Discussionmentioning

confidence: 99%

Distally based peroneus brevis muscle flap: A single centre experience

Sahu

Gohil

Patil

et al. 2019

Chinese Journal of Traumatology

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Purpose Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results There were 21 males and 4 females with the mean age of 39 (5–76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4–50) cm 2 . The mean operating time was 75 (60–90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting. Conclusion The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.

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“…Such a problem does not change opinions of reconstructive surgery that it is the most valuable flap for reconstruction defects in the lower leg and foot (Hallock, 1991;Arnold;Gonzalez et al;Benito-Ruiz et al). However, it was reported recently that applying post-operative negative pressure therapy (75 mmHg) has a significant effect in reducing the postoperative complication of the flap (Erne et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

The Anatomical Basis of the Vascularized Fibularis Brevis Grafts

Elbarrany

Alasmari

2018

Int. J. Morphol.

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Fibularis brevis grafts have been extensively used, especially as distally-based grafts, to cover defects in the lower leg and foot. The study has contributed to analyze the blood supply of the fibularis brevis muscle and the vascular basis of its possible different grafts. Both legs of twelve preserved cadavers, without congenital vascular anomalies, were utilized in the study. Fibularis brevis was exposed in all selected legs along with the verification of different arterial pedicles. The total means and standard deviations of the length and width of the muscle together with diameters of major vessels were calculated. Total length and width of middle portion of fibularis brevis were at means of 28.7±0.4 cm and 3±0.02 cm respectively. The upper and middle portions of the muscle were supplied by the fibular and the anterior tibial artery. The middle portion was supplemented by the upper perforating branch of the posterior tibial artery. The lower portion of the muscle was supplied by the lower perforating branch of the posterior tibial and the periosteal arteries. The muscle could be used as a proximally or distally based flap, free vascularized muscle graft, free vascularized osteo-muscular flap, and distally-based split flap. It can be split completely into two flaps; each of which can be used as a proximally or distally.

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Postoperative negative pressure therapy significantly reduces flap complications in distally based peroneus brevis flaps: Experiences from 74 cases

Cited by 9 publications

References 18 publications

Distally Based Peroneus Brevis Muscle Flap for Lower Extremity Defect Reconstruction in Severely Ill Multimorbid Patients

Distally Based Peroneus Brevis Muscle Flap for Lower Extremity Defect Reconstruction in Severely Ill Multimorbid Patients

Distally based peroneus brevis muscle flap: A single centre experience

The Anatomical Basis of the Vascularized Fibularis Brevis Grafts

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