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 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.

Perforator Free Flap Coverage of Chronic Lower Extremity Ulcers in Patients With Autoimmune Diseases Under Immunosuppression

2020 ◽  
pp. 153473462091961
Author(s):  
Sang Wha Kim
Keyword(s):  
Lower Extremity ◽  
Autoimmune Diseases ◽  
Free Flap ◽  
Donor Site ◽  
Wound Dehiscence ◽  
High Rate ◽  
Flap Transfer ◽  
Epigastric Artery ◽  
Free Flap Transfer ◽  
Deep Inferior Epigastric Artery

Objectives. Lower extremity ulcers are quite common in patients with autoimmune diseases. Due to chronic use of immunosuppressants, these wounds may develop into deeper wounds resulting in exposure of bone or tendon, which in turn may require free tissue transfers for coverage. The author reviewed perforator free flap transfers performed in this group of patients and analyzed the results. Methods. A retrospective review was performed on all patients who underwent perforator free flap transfer for coverage of lower extremity ulcers without trauma, over a 10-year period. Patient demographics, administered immunosuppressants, and flap and donor site complications were analyzed. Results. Twenty-two perforator free flap transfers were performed in patients with autoimmune diseases, including 18 thoracodorsal perforator flaps, 2 anterolateral thigh flaps, and 2 deep inferior epigastric artery flaps. There was no total flap loss, but there was a high rate of partial flap necrosis (40.9%) and wound dehiscence (40.9%). Intake of corticosteroids was significantly associated with postoperative complications ( P < .05). Conclusion. As partial loss of flap and wound dehiscence is much more common in this group of patients, treatment may take longer, and a fully informed consent should be obtained preoperatively. Surgeons should not avoid performing perforator free flap transfers in patients with autoimmune diseases under immunosuppression; instead, much more preparation and caution are required.

Results of combined vascular reconstruction by means of AV loops and free flap transfer in patients with soft tissue defects

2016 ◽  
Vol 69 (4) ◽  
pp. 545-553 ◽  
Author(s):  
Alexander Meyer ◽  
Raymund E. Horch ◽  
Elisabeth Schoengart ◽  
Justus P. Beier ◽  
Christian D. Taeger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Vascular Reconstruction ◽  
Soft Tissue Defects ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Tissue Defects

Functional Evaluation of Nonsensate Free Flaps to the Sole of the Foot

Foot & Ankle ◽  
1986 ◽  
Vol 7 (2) ◽  
pp. 118-123 ◽  
Author(s):  
Ramesh Gidumal ◽  
Allen Carl ◽  
Phillip Evanski ◽  
William Shaw ◽  
Theodore R. Waugh
Keyword(s):  
Soft Tissue ◽  
Free Flap ◽  
Older Patients ◽  
Free Flaps ◽  
Functional Evaluation ◽  
Soft Tissue Defects ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Tissue Defects ◽  
Sole Of The Foot

Free flap transfer for soft tissue defects involving the sole of the foot have been important in limb salvage. The functional capacity of 16 patients is documented. From our data, free flaps to weightbearing surfaces of the foot give satisfactory results in patients less than 40 years old and salvage is rewarding. Older patients had less than satisfactory results. When the only alternative is an amputation, free flap salvage may still be indicated.

scholarly journals Reconstruction of Axillary Defect due to Necrotizing Fasciitis and Debridement Using a Free-Flap Transfer: A Report of Three Cases

2021 ◽  
Vol 06 (02) ◽  
pp. e63-e69
Author(s):  
Haruo Ogawa ◽  
Haruki Nakayama ◽  
Shinichi Nakayama ◽  
Shinya Tahara
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Free Flap ◽  
Radical Resection ◽  
The Body ◽  
Tissue Infection ◽  
Infected Tissue ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Radical Debridement

Abstract Background Necrotizing fasciitis is a well-known disease that causes extensive tissue infection and requires radical debridement of the infected tissue. It can occur in all parts of the body, but there are few reports of necrotizing fasciitis in the axilla. We treated three patients with axillary necrotizing fasciitis. Methods In all cases, patients were referred to us after radical debridement of the infected soft tissue in the emergency department. At the first visit to our department, there were fist-sized soft tissue defects in the axilla. Moreover, the ipsilateral pectoralis major and latissimus dorsi muscles were partially resected because of the debridement of necrotizing fasciitis. In all cases, the ipsilateral thoracodorsal vessels were severely damaged and free-flap transfer was performed to close the axillary wound. Results All free flaps survived without complications. The patient's range of motion for shoulder abduction on the affected side was maintained postoperatively. Conclusion If necrotizing fasciitis occurs in the axilla, tissue infection can spread beyond it. In such a case, free-flap transfer can be an optimal treatment. Radical resection of the infected tissue results in the absence of recipient vessels in the axilla. Surgeons should bear in mind that, because of radical resection of the infected tissue, they may need to seek recipient vessels for free-flap transfer far from the axilla.

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