The Repair of Soft Tissue Defects in the Lower Leg: A Comparison of Different Flap Techniques

Riegels-Nielsen, Per; Krag, Christen; Medgyesi, Sandor; Pers, M

doi:10.3109/17453678308996628

Cited by 7 publications

(3 citation statements)

References 34 publications

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“…and Mathes (1982), Fitzgerald et al (1985) in different series. They demonstrated that muscle provided greater oxygen delivery in cellular and non-cellular environment at the site of infection and increase of concentration of antibiotics in a fibrotic cavity in an experimental animal, Russell and Graham (1988) [15]. Kojima and Kohno (1979) pointed out disadvantage of primary grafting that oozing from the Muscle flap interferes with grafted skin, leading to necrosis and may require regrafting.…”

Section: Discussionmentioning

confidence: 99%

Roll of Local Flap Technique in the Management of Compound Injuries of Leg

SADH,

PAL

2024

Asian J Pharm Clin Res

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Objective: The objective of this study was to study the feasibility of local flaps in management of soft-tissue defects with exposed fracture bone fragments in lower extremity (particularly the leg) due to trauma. Methods: The present study included 20 cases of traumatized lower extremity having a soft-tissue defect and an exposed bone with or without associated fractures. Study was conducted from January 1989 to August 1990. Local flaps provide a reliable single stage procedure for coverage of lower extremity soft-tissue defects. Distant flap provides good coverage but these procedures are long drown out and tedious. Only those cases were selected in which wound was found to be preferably, in the upper 1/3rd, middle 1/3rd and the upper most part of the lower third of the leg due to easy accessibility and placement of the flaps to these area. (As flaps can easily be transposed to these areas). All flaps, that is, Fasciocutaneous, Musculocutaneous, or local Muscle flaps were under taken as a delayed procedure after careful evaluation of traumatized limb, that is, repeated dressing, debridement and control of infection. Results: In this study, stable wound coverage was achieved in all patients. Most of the patients were in the age group of 18 to 42 (55%), of these 90% were male. The longest duration of follow-up was 14 months and shortest was 3 months. Excellent result were obtained in Muscle and Musculocutaneous flaps while good result was obtained in 10% cases of Fasciocutaneous flap. Conclusion: Stable coverage can be achieved by flap techniques using Fasciocutaneous Muscle of Musculocutaneous flaps. Coverage of exposed cartical bones, tendon and major vessels and adequate control of infection can be achieved by Muscle and Musculocutaneous flap in post traumatized limb. Fasciocutaneous flap (Ponten super flap) is very useful in repair of soft-tissue defect asit is a much simpler, easy to design and construct large flaps are safe due to good circulations, requires less time without any functional loss. Post-operative management is simple for both patient and staff.

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Section: Discussionmentioning

confidence: 99%

Roll of Local Flap Technique in the Management of Compound Injuries of Leg

SADH,

PAL

2024

Asian J Pharm Clin Res

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“…Contudo, quando necessário, procede-se, de rotina, ao uso de dois ou mais músculos, migrando-os parcialmente, procurando preservar a função do membro inferior, deixando a inserção tendinosa distal intacta, evitando-se sequelas funcionais irreversíveis, como quando são usados retalhos musculares múltiplos totais [33][34][35] . Porém, vem crescendo na última década o uso dos retalhos musculares ou subcutâneos para o tratamento de áreas cruentas em membros inferiores 12,36,37,38 .…”

Section: Discussionunclassified

Utilização do músculo sóleo para perdas musculocutâneas de terço médio da perna

Bacelar¹

2011

Rev. Bras. Cir. Plást. (Impr.)

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211Utilização do músculo sóleo para perdas musculocutâneas de terço médio da perna Utilização do músculo sóleo para perdas musculocutâneas de terço médio da pernaThe use of soleus muscle flap in musculocutaneus losses of the middle third of lower leg RESUMO Introdução: Áreas lesionadas de membros inferiores são portas abertas à infecção, às perdas de plasma, sangue, eletrólitos e líquidos, além de serem responsáveis por dor intensa. Por isso, é necessário cobri-las o mais rapidamente possível, para que o paciente se estabilize precocemente, prevenindo complicações e futuras sequelas. Os retalhos musculares e musculocutâneos são opções de reparo cirúrgico destas áreas. Ao longo dos anos, sugeriram vários tratamentos com retalhos para reparações de lesões, dentre eles o retalho do músculo sóleo, foco deste trabalho. Objetivo: Relatar a experiência do autor empregando a rotação do músculo sóleo. Método: Foram tratados cirurgicamente 18 pacientes com perda de substância no terço medial da perna, utilizando a rotação do músculo sóleo, no período de 2008 a 2010. Resultados: Os resultados obtidos foram satisfatórios e sem complicações maiores. Conclusão: Este procedimento é um recurso para o tratamento de lesões decorrentes de diferentes etiologias, como úlceras, osteomielite, perda de substância cutânea de terço médio da perna e cobertura cutânea em lesões com exposição de estruturas osteotendinosas, tornando-se uma ferramenta de grande auxílio ao cirurgião plástico.Descritores: Músculo Esquelético. Extremidade Inferior. Retalhos Cirúrgicos. Procedimentos cirúrgicos reconstrutivos. ABSTRACT Introduction:Lower limb damaged areas are open doors to infection, to the loss of plasma, blood, electrolytes and fluids, in addition to being responsible for intense pain. Therefore it is necessary to cover them as soon as possible so that the patient can be stabilized preventing early complications and future sequels. Muscle and musculocutaneous flaps are used to repair these areas. Over the years several treatments with flaps have been suggested for injuries repairment, among them the soleus muscle flap, the focus of this work. Objective: To describe the author's experience using the rotation of the soleus muscle. Methods: Eighteen patients with loss of substance of the medial third of the leg were treated by using the rotation of the soleus muscle, from 2008 to 2010. Results: The results were satisfactory and without major complications. Conclusion: This is an option to treat lesions caused by various etiologies such as ulcers, osteomyelitis, loss of cutaneous substance of third middle leg, and to cover skin lesions with exposure of osteotendinous structures, becoming a great assistance tool to the plastic surgeon.

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“…[10][11][12] Of these options, muscle flaps and dorsalis pedis island flaps have been shown to have lower complication rates, shorter hospital stay and shorter theatre time. [12][13][14] Gopal et al reported a series of nine pedicle flaps and 75 free muscle flaps. They recorded a 3.5% flap failure rate after immediate internal fixation followed by soft tissue reconstruction if performed within 72 hours after injury.…”

Section: Introductionmentioning

confidence: 99%

Soft tissue reconstruction of Gustilo-Anderson grade 3B open tibia fractures at a tertiary hospital: a retrospective case series

Maimin,

Barouni,

Price

et al. 2023

SA orthop. j.

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BackgroundThe management of Gustilo-Anderson grade 3B open tibia fractures are challenging due to the high complication rates, including infection, non-union and amputation. Despite developing treatment options for these injuries, the optimal soft tissue cover option and timing of definitive surgery remains unclear and is often dictated by local context and available surgical expertise rather than the gold standard of care. The authors aimed to review the surgical techniques and outcomes for the management and reconstruction of the soft tissues in Gustilo-Anderson grade 3B tibia fractures treated at a tertiary hospital in South Africa. MethodsA retrospective study was conducted on 22 patients who underwent soft tissue reconstruction for grade 3B tibia fractures from January 2014 to July 2017. Patient demographics, medical comorbidities, injury characteristics and management practices such as time to debridement, relook time, use of negative pressure wound therapy (NPWT), soft tissue coverage techniques and complications were recorded and analysed. ResultsMost patients were males (n = 18; 82%) with an average age of 39.3 years (range 15-69). Pedestrian vehicle accidents accounted for 45% (n = 10), followed by motor vehicle accidents (n = 6; 27%) and gunshot wounds (n = 2; 9%). Most patients (n = 18; 82%) were initially debrided within 24 hours. The mean time for NPWT usage prior to cover was 12.5 days. The mean time before soft tissue cover was attempted was 13.7 days (range 2-35). Fasciocutaneous flaps (n = 11; 50%) were the most common method used to achieve bony cover, followed by pedicled muscle flaps (n = 8; 36%), free flaps (n = 2; 9%) and skin grafts (n = 1; 5%). Most patients (n = 13; 59%) achieved satisfactory outcomes. Seven (32%) required soft tissue revisions. Additional complications included complete flap loss resulting in amputation, partial skin graft loss and soft tissue infection. Fewer complications were seen in patients who were first debrided within 24 hours from time of injury. ConclusionDue to a resource constraint in our working environment, it is not possible to accurately follow available treatment guidelines in our management of grade 3B open tibia fractures. Despite this, the outcomes seen in this small sample were in keeping with those seen in the literature.

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The Repair of Soft Tissue Defects in the Lower Leg: A Comparison of Different Flap Techniques

Cited by 7 publications

References 34 publications

Roll of Local Flap Technique in the Management of Compound Injuries of Leg

Roll of Local Flap Technique in the Management of Compound Injuries of Leg

Utilização do músculo sóleo para perdas musculocutâneas de terço médio da perna

Soft tissue reconstruction of Gustilo-Anderson grade 3B open tibia fractures at a tertiary hospital: a retrospective case series

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