scholarly journals Flaps Insetting and Stabilization with External Fixation in Lower Limb Reconstruction: “Thinking Outside the Box”

2018 ◽  
Vol 1 (1) ◽  
pp. 32-34
Author(s):  
Edgardo Rodriguez-Collazo ◽  
Alessandro Thione ◽  
Jose Sous ◽  
Ercin Burak Sercan
Keyword(s):  
External Fixation ◽  
Lower Limb ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction ◽  
Outside The Box

scholarly journals Microsurgery and external fixation in orthoplastic reconstruction of tibial injuries

2019 ◽  
Vol 51 (06) ◽  
pp. 484-491
Author(s):  
Francesca Toia ◽  
Giovanni Zabbia ◽  
Roberto Scirpo ◽  
Roberto Pirrello ◽  
Lorenzo Nalbone ◽  
...  
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Lower Limb ◽  
Soft Tissues ◽  
Treatment Time ◽  
Soft Tissue Defect ◽  
Soft Tissue Reconstruction ◽  
Microsurgical Reconstruction ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction

Abstract Background “Orthoplastics” is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. Material and methods Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. Results In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. Conclusion The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction.

Free Flaps in Complex Lower Limb Reconstruction - 2-Year Experience

2014 ◽  
Vol 30 (S 01) ◽  
Author(s):  
Horácio Zenha ◽  
Carla Diogo ◽  
Sara Ramos ◽  
Susana Pinheiro ◽  
Ricardo Carvalho ◽  
...  
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction

Canadian Trends in Free Flap Management for Microsurgical Lower Limb Reconstruction

2021 ◽  
pp. 229255032110196
Author(s):  
Michelle Bonapace-Potvin ◽  
Alexander Govshievich ◽  
Laurent Tessier ◽  
Mihiran Karunanayake ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Online Questionnaire ◽  
Limb Reconstruction ◽  
Changing Practice ◽  
Current State ◽  
Lower Limb Reconstruction ◽  
Tumor Extirpation ◽  
Based Medicine ◽  
Previous Training

Introduction: Free tissue transfers have become a mainstay in lower limb salvage, allowing safe and reliable reconstruction after trauma, tumor extirpation, and complex wounds. The optimal perioperative (PO) management of these flaps remains controversial. This study aims to assess the current state of practice among Canadian microsurgeons. Methods: Sixty-four Canadian microsurgeons were approached to complete an online questionnaire regarding their PO management of fasciocutaneous free flaps used for lower limb reconstruction. Trends in dangling timing and duration, use of venous couplers, compressive garments, thromboprophylaxis, and surgeons’ satisfaction with their protocol were assessed. Results: Twenty-eight surgeons responded. Fifty-seven percent did not have a specific mobilization protocol. Dangling was mainly initiated on postoperative days 5 to 6 (44%). The most common protocol duration was 5 to 6 days (43%). The concern for prolonged venous pooling was the main reason for delay of dangling (71%). Compressive garments were placed routinely by 12 surgeons (43%) with 20% starting before dangling, 46% with dangling, and 33% after dangling. Venous couplers were routinely used by 24 surgeons (85.7%). Trends in management were influenced by previous training in 53.6% of cases (vs evidence-based medicine 7.1%). Although 89.3% were satisfied with their approach, 92.8% would consider changing practice if higher-level evidence was available. Conclusions: The majority of Canadian microsurgeons initiate dangling early and utilize venous couplers. However, the use of compressive garments is limited. Trends in management are largely based on personal experience. Nearly all surgeons would consider changing their practice if higher-level evidence was available.

Lower limb reconstruction with bone free flaps: experience of 25 cases

2011 ◽  
Vol 35 (5) ◽  
pp. 359-364
Author(s):  
Luís Azevedo ◽  
Horácio Zenha ◽  
Leonor Rios ◽  
Hugo Sequeira ◽  
Gustavo Coelho ◽  
...  
Keyword(s):  
Lower Limb ◽  
Free Flaps ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction

Lower limb reconstruction

2015 ◽  
pp. 607-627
Author(s):  
James K. Chan ◽  
Matthew D. Gardiner ◽  
Michael Pearse ◽  
Jagdeep Nanchahal
Keyword(s):  
Lower Limb ◽  
Limb Reconstruction ◽  
Lower Limb Reconstruction
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