Progressive trends in timing and imaging of lower extremity reconstruction

Zhang, Andrew Y.; Cholok, David; Lee, Gordon K.

doi:10.20517/2347-9264.2019.040

Cited by 2 publications

(4 citation statements)

References 60 publications

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“…This decreases donor-site morbidity, which is particularly important in the trauma population. In weight-bearing areas, fasciocutaneous flaps are more resistant to breakdown and shear than muscle flaps [ 85 ]. Fasciocutaneous flaps are also easier to re-elevate for hardware revision or bone grafting, if needed.…”

Section: Reviewmentioning

confidence: 99%

“…Finally, the past decade has seen increasing usage of ICG fluorescent dye with near infrared imaging as an adjunct to assess skin flap viability. It has been used across numerous specialties to evaluate vascular perfusion and lymphatic drainage [ 85 , 108 ]. It now has applications as a useful tool to assess perforator perfusion distribution for flap design, and has also demonstrated efficacy as an adjunct to guide debridement in Gustilo IIIB lower extremity fractures [ 109 , 110 ].…”

Section: Reviewmentioning

confidence: 99%

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Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

Zeiderman

2021

Burns &Amp; Trauma

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The complex lower extremity wound is frequently encountered by orthopedic and plastic surgeons. Innovations in wound care, soft tissue coverage and surgical fixation techniques allow for improved functional outcomes in this patient population with highly morbid injuries. In this review, the principles of reconstruction of complex lower extremity traumatic wounds are outlined. These principles include appropriate initial evaluation of the patient and mangled extremity, as well as appropriate patient selection for limb salvage. The authors emphasize proper planning for reconstruction, timing of reconstruction and the importance of an understanding of the most appropriate reconstructive option. The role of different reconstructive and wound care modalities is discussed, notably negative pressure wound therapy and dermal substitutes. The role of pedicled flaps and microvascular free-tissue transfer are discussed, as are innovations in understanding of perforator anatomy and perforator flap surgery that have broadened the reconstruction surgeon’s armamentarium. Finally, the importance of a multidisciplinary team is highlighted via the principle of the orthoplastic approach to management of complex lower extremity wounds. Upon completion of this review, the reader should have a thorough understanding of the principles of contemporary lower extremity reconstruction.

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Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

Zeiderman

2021

Burns &Amp; Trauma

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“…8,12,15,19 In the trauma setting, preoperative CT angiography is primarily indicated in the instances of suspected vascular injury and/or preoperative surgical planning, and it is uncommonly used to diagnose PAD. 20 vascular assessment and 2 patients had a vascular consult. The indications for 95.3% of those who received a preoperative assessment were either suspected vascular injury, flap planning, or both.…”

Section: Discussionmentioning

confidence: 99%

“…In the trauma setting, preoperative CT angiography is primarily indicated in the instances of suspected vascular injury and/or preoperative surgical planning, and it is uncommonly used to diagnose PAD 20 . Only 50.9% of high- or intermediate-risk patients received a preoperative vascular assessment and 2 patients had a vascular consult.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Complications in Patients Undergoing Limb Salvage Reconstructive Surgery Based on Estimated Prevalence of Preexisting Peripheral Arterial Disease

Pekcan,

Roohani,

Stoneburner

et al. 2023

Ann Plast Surg

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Background Limb salvage after lower extremity (LE) trauma requires optimal blood flow for successful microsurgical reconstruction. Peripheral arterial disease (PAD) decreases LE perfusion, affecting wound healing. Patients who present with LE trauma may have undiagnosed PAD, particularly those with atherosclerotic risk factors. This study assesses outcomes after LE salvage in patients at risk for PAD. Methods This retrospective review evaluated patients who underwent LE reconstruction at a level 1 trauma center between 2007 and 2022. Patients with a nontraumatic mechanism of injury, missing postoperative records, and unspecified race were excluded. Demographics, flap characteristics, and postoperative complications were abstracted. The prevalence of LE PAD was calculated using a validated risk assessment tool. Results At our institution, 285 LE flaps performed on 254 patients were included in the study. Patients were categorized by prevalence of PAD, including 12 (4.7%) with high risk, 45 (17.7%) with intermediate risk, and 197 (77.6%) patients with low risk. The high-risk cohort had higher rates of partial flap necrosis (P = 0.037), flap loss (P = 0.006), and amputation (P < 0.001) compared with the low-risk group. Fewer high-risk patients achieved full ambulation compared with the low-risk (P = 0.005) cohort. Overall flap survival and limb salvage rates were 94.5% and 96.5%, respectively. Among the intermediate- and high-risk cohorts, only 50.9% of patients received a preoperative vascular assessment, and 3.8% received a vascular surgery consultation. Conclusions Peripheral arterial disease represents a reconstructive challenge to microvascular surgeons. Patients with high-risk for PAD had higher rates of partial flap necrosis, flap loss, and amputation. In the setting of trauma, emphasis should be placed on preoperative vascular assessment for patients at risk of having undiagnosed PAD. Prospective studies collecting ankle-brachial index assessments and/or angiography will help validate this study's findings.

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Progressive trends in timing and imaging of lower extremity reconstruction

Cited by 2 publications

References 60 publications

Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma

Comparison of Postoperative Complications in Patients Undergoing Limb Salvage Reconstructive Surgery Based on Estimated Prevalence of Preexisting Peripheral Arterial Disease

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