Optimizing venous outflow in reconstruction of Gustilo IIIB lower extremity traumas with soft tissue free flap coverage: Are two veins better than one?

Microsurgery ◽  
2017 ◽  
Vol 38 (7) ◽  
pp. 745-751 ◽  
Author(s):  
John T. Stranix ◽  
Z-Hye Lee ◽  
Lavinia Anzai ◽  
Adam Jacoby ◽  
Tomer Avraham ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Free Flap ◽  
Venous Outflow ◽  
Flap Coverage ◽  
Better Than

Surgical Strategies: Necrotizing Fasciitis of the Foot and Ankle Treated With Dermal Regeneration Matrix for Limb Salvage

2020 ◽  
pp. 107110072095208
Author(s):  
Arvind S. Narayanan ◽  
Kempland C. Walley ◽  
Todd Borenstein ◽  
G. Aman Luther ◽  
J. Benjamin Jackson ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Necrotizing Fasciitis ◽  
Limb Salvage ◽  
Free Flap ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Flap Coverage ◽  
Split Thickness Skin Grafting ◽  
Dermal Regeneration

Although necrotizing fasciitis is a life-threatening entity that needs expeditious treatment, cases involving the lower extremity are less commonly encountered than in the upper extremity. Surgical intervention is often required and likely lead to amputation (below-knee or above-knee) vs debridement in the lower extremity. Coverage options in the foot and ankle after serial debridements can present many challenges for limb salvage. Patients are often left with large soft tissue defects requiring coverage with a subsequent increase in relative morbidity. Treatment options for coverage in these cases include negative-pressure wound therapy, split-thickness skin grafting, free flap coverage, or higher-level amputation. In the diabetic population, who present with a lower extremity necrotizing infection, limb salvage is often a challenge given the multiple comorbidities associated with these patients including peripheral vascular disease, immunocompromised state, and neuropathy. Optimal treatment strategies for these necrotizing infections in the foot and ankle remain uncertain. We offer a technique tip for utilization of a dermal regeneration matrix to allow coverage of large soft tissue defect with exposed tendon and/or bone without the need for free flap coverage or higher-level amputation, thus allowing for an additional limb salvage option. Level of Evidence: Level V, expert opinion.

scholarly journals Timing of management of severe injuries of the lower extremity by free flap transfer

2005 ◽  
Vol 5 (4) ◽  
pp. 7-13 ◽  
Author(s):  
Ulf Dornseifer ◽  
Milomir Ninković
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Free Flap ◽  
High Energy ◽  
Soft Tissue Defect ◽  
Severe Injuries ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Aesthetic Results ◽  
Flap Closure

Covering defects by free-tissue transfers enable surgeons to reconstruct or salvage the lower extremity injured or amputated in high-energy traumas which result in extensive damage to soft tissue, bone, tendons, vessels and nerve. The timing of the reconstruction using flaptechniques is extremely important. It can be divided into three categories: "primary free flap closure" (12 to 24 hours), "delayed primary free flap closure" (2 to 7 days), and "secondary free flap closure" (after 7 days). Our treatment of choice in an isolated complex injury of a lower extremity with a soft tissue defect is "primary free flap closure" providing improved funcional and aesthetic results, and psychologically benefit through lowered morbidity of the patient.

scholarly journals Free Flap Coverage of Extensive Soft Tissue Defect in Cutaneous Aspergillosis: A Case Report

2008 ◽  
Vol 23 (5) ◽  
pp. 920 ◽  
Author(s):  
Chan Yeong Heo ◽  
Seok Chan Eun ◽  
Rong Min Baek ◽  
Kyung Won Minn
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Free Flap ◽  
Soft Tissue Defect ◽  
Tissue Defect ◽  
Flap Coverage

scholarly journals A Combined Use of a Free Vascularised Flap and an External Fixator for Reconstruction of Lower Extremity Defects in Children

2007 ◽  
Vol 15 (2) ◽  
pp. 207-210 ◽  
Author(s):  
E Segev ◽  
S Wientroub ◽  
Y Kollender ◽  
I Meller ◽  
A Amir ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Free Flap ◽  
External Fixator ◽  
Kirschner Wire ◽  
External Fixators ◽  
Neutral Position ◽  
Combined Use ◽  
Equinus Contracture ◽  
Tract Infections

Purpose. To describe a combined use of a free vascularised flap and an external fixator for reconstruction of lower extremity defects in children, and correction of equinus contracture developed after removal of the external fixator using a circular dynamic frame. Methods. Seven children (4 males) aged 4 to 12 (mean, 8) years were treated with 9 free vascularised flaps for 8 limbs (bilaterally in one patient and for a failed flap in another). Patient pathologies included: 3 soft tissue degloving injuries, one soft tissue and bone avulsion, one severe burn contracture, one resurfacing of soft tissue and bone necrosis, and one osteosarcoma resection defect. Free flap reconstruction was delayed in 6 patients (range, 3 weeks to 4 years). Static external fixators were used to stabilise the free vascularised flaps at the time of reconstruction, with the ankle in a neutral position. Results. The mean follow-up was 5 (1–10) years. All flaps but one survived; the failed one was immediately reconstructed with a contralateral, latissimus dorsi flap. One anastomosis following a Kirschner-wire injury was successfully revised. Six patients had pin tract infections and were treated with oral antibiotics. Two patients developed equinus contracture 6 and 3 years later, after removal of the external fixator, and were corrected by distraction, using a dynamic Ilizarov frame. Conclusion. The combined use of a free flap and an external fixator for salvage of lower extremities is useful in children. Late development of equinus contracture can be safely corrected by distraction, without compromising flap viability.

scholarly journals Free Flap Transfer to Preserve Main Arterial Flow in Early Reconstruction of Open Fracture in the Lower Extremity

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mitsuru Nemoto ◽  
Shinsuke Ishikawa ◽  
Natsuko Kounoike ◽  
Takayuki Sugimoto ◽  
Akira Takeda
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Free Flap ◽  
Open Fracture ◽  
Posterior Tibial Artery ◽  
Flap Transfer ◽  
Posterior Tibial ◽  
Free Flap Transfer ◽  
Flow Through ◽  
Tissue Defects

The selection of recipient vessels is crucial when reconstructing traumatized lower extremities using a free flap. When the dorsalis pedis artery and/or posterior tibial artery cannot be palpated, we utilize computed tomography angiography to verify the site of vascular injury prior to performing free flap transfer. For vascular anastomosis, we fundamentally perform end-to-side anastomosis or flow-through anastomosis to preserve the main arterial flow. In addition, in open fracture of the lower extremity, we utilize the anterolateral thigh flap for moderate soft tissue defects and the latissimus dorsi musculocutaneous flap for extensive soft tissue defects. The free flaps used in these two techniques are long and include a large-caliber pedicle, and reconstruction can be performed with either the anterior or posterior tibial artery. The preparation of recipient vessels is easier during the acute phase early after injury, when there is no influence of scarring. A free flap allows flow-through anastomosis and is thus optimal for open fracture of the lower extremity that requires simultaneous reconstruction of main vessel injury and soft tissue defect from the middle to distal thirds of the lower extremity.

Lower extremity reconstruction using a long-cryopreserved venous allograft for free flap venous outflow

Microsurgery ◽  
1992 ◽  
Vol 13 (2) ◽  
pp. 59-61 ◽  
Author(s):  
Marc D. Liang ◽  
Krishna Narayanan ◽  
Sai S. Ramasastry ◽  
Guy Stofman
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Venous Outflow ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction
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