Selecting a free flap for soft tissue coverage in lower extremity reconstruction

Kozusko, Steven D.; Liu, X.; Riccio, Charles A; Chang, Jeremy; Boyd, Louisa; Kokkalis, Zinon T.; Konofaos, Petros

doi:10.1016/j.injury.2019.10.045

Cited by 73 publications

(73 citation statements)

References 70 publications

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“…Anterolateral thigh flap (ALT) is the workhorse flaps of free tissue transfer and has been widely used for the softtissue defect of lower extremity. 41,42 However, ALT flap is also limited by demanding microsurgery, vascular crisis, and secondary thinning procedures for bulky flap. 43 The sural flap can be harvested easily without vascular anastomosis and has reliable blood supply without sacrificing the main vessel of leg.…”

Section: Discussionmentioning

confidence: 99%

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Zhou

Wei

Peng

et al. 2021

J Reconstr Microsurg

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Background This study is to describe the distribution of natural true anastomoses associated with the distally based perforator-plus sural neurocutaneous flap (sural flap), summarize our experience in the flap with high pivot point, and compare the outcomes between the flaps with high and low pivot points. Methods Five amputated lower limbs were perfused, and the integuments were radiographed. We retrospectively analyzed 378 flaps, which were divided into two groups: pivot points located ≤8.0 cm (low pivot point group) and >8.0 cm (high pivot point group) proximal to the tip of the lateral malleolus. Partial necrosis rates were compared between two groups. Results The arterial chain surrounding the sural nerve was linked by true anastomoses from the intermalleolar line to popliteal crease. True anastomoses existed among peroneal perforators and between these perforators and the arterial chain. There were 93 flaps with high pivot point and 285 flaps with low pivot point. Partial necrosis rates were 16 and 9.1% in the high and low pivot point group (p = 0.059), respectively. Conclusion True anastomosis connections among peroneal perforators and the whole arterial chain around sural nerve enable the sural flap to survive with a greater length. The sural flap with high pivot point is a good option for reconstructing soft-tissue defects in the middle and distal leg, ankle, and foot, particularly when the lowest peroneal perforator presents damage, greater distance to the defects, discontinuity with the donor site, or anatomical variation.

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Section: Discussionmentioning

confidence: 99%

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Zhou

Wei

Peng

et al. 2021

J Reconstr Microsurg

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“…Operations: Ratio between Flap elevation time and total operation time range from 1:2.5 (40%) to 1:11 (9%) (Median 29%, Mean 26±10 SD %). More details are shown in Table (4).…”

Section: (1)mentioning

confidence: 99%

“…Almost every method of coverage is reliable when it is performed in the selected patients with indicated defects by the expertise-hands. The Free flap is nearly the only solution for the large complex defects in a patient with average medical fitness and healthy vessels [4]. The Cross-leg flap is the last resort for limb salvage when a Free flap is not suitable or contraindicated [5].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of the Free-Style, Perforator-Plus Flap in the Reconstruction of the Soft Tissue Defects at the Lower Leg and Ankle Regions

Younes

Elhabaa

Gazzar

et al. 2021

The Egyptian Journal of Plastic and Reconstructive Surgery

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“…For smaller defects, local rotational muscle flaps can help to provide an adequate local blood supply, which is essential for fracture healing. For larger defects, fasciocutaneous (ie, anterolateral thigh) or muscle (ie, rectus abdominis, latissimus dorsi) free flaps can also achieve similar goals, with recent data suggesting that fasciocutaneous flaps may be associated with delayed union compared to muscle flaps (1) .…”

Section: Introductionmentioning

confidence: 96%

Free adipose tissue (FAT) graft pooling for severe dead space management

et al. 2020

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Complex lower extremity trauma with large soft tissue defects requires early wound coverage to reduce the risk of complications. In particular circumstances, however, local or free flaps may be contraindicated due to local or systemic issues. This study presents a helpful and effective salvage procedure for soft tissue reconstruction that uses autologous fat grafting combined with negative pressure wound therapy. Level of Evidence V; Therapeutic Studies; Expert Opinion.

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Selecting a free flap for soft tissue coverage in lower extremity reconstruction

Cited by 73 publications

References 70 publications

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Efficacy of the Free-Style, Perforator-Plus Flap in the Reconstruction of the Soft Tissue Defects at the Lower Leg and Ankle Regions

Free adipose tissue (FAT) graft pooling for severe dead space management

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