scholarly journals Recycling of flap pedicle in complex lower extremity reconstruction: A proof of free muscle flap neovascularization

2020 ◽  
Vol 47 (6) ◽  
pp. 619-621
Author(s):  
Georgios Pafitanis ◽  
Alexandros Vris ◽  
Dimitris Reissis ◽  
Amir Sadri ◽  
Reza Alamouti ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Muscle Flap ◽  
Complex Case ◽  
Anterolateral Thigh Flap ◽  
Term Survival ◽  
Vein Grafts ◽  
Free Muscle Flap ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

This article portrays the authors’ clinical experience of a complex case of lower extremity reconstruction using a recycled pedicle from 10 years old free latissimus dorsi musculocutaneous flap to supply a new free anterolateral thigh flap for proximal tibia wound defect reconstruction. It provides clinical evidence that muscle neovascularization occurs and supports the dogma peripheral tissue neovascularization. This case stipulates that recycling of pedicle is feasible, when used with appropriate strategy and safety and also provides evidence for the long-term survival of greater saphenous vein grafts in lower extremity reconstruction.

Challenges of Setting up a Lower Extremity Reconstruction Practice in a Constrained Environment

2020 ◽  
Author(s):  
Asli Datli ◽  
Ismail Karasoy ◽  
Yucel Genc ◽  
Ozgur Pilanci
Keyword(s):  
Lower Extremity ◽  
Administrative Support ◽  
Tertiary Care ◽  
Perforator Flap ◽  
Operation Time ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Set Up

Abstract Background Microsurgical lower extremity reconstruction remains challenging, especially when resources are limited such as lack of proper equipment, human resources, administrative support, and located in a remote area far from tertiary care. Nevertheless, reconstructive solutions are required, especially when in urgent trauma situations. In this article, we evaluate ways of overcoming challenges and issues that should be considered in a newly established unit by sharing our initial lower extremity reconstruction experience. Methods We report a local hospital's initial lower extremity reconstruction experience in February 2017 to January 2018. Through a total of seven patients, we tried to enhance the environment, instruments, nurses' contribution, and perspective of the peers and community in terms of factors related to the surgeon, hardware, environment, supporting faculty, reimbursement, and patients. Results Four patients underwent reconstruction with a freestyle propeller flap and three with an anterolateral thigh flap; in one case, a superficial circumflex iliac artery perforator flap was chosen to salvage partial flap necrosis. Increased experience of the surgeon, new equipment, continuing nurse/patient education, and collaborating with other departments allowed us to choose more challenging flaps and be more meticulous while decreasing the operation time and hospital stay. Conclusion To start a lower extremity reconstruction practice in a resource-poor environment, the surgeon needs to evaluate the relevant factors; moreover, he or she should continuously improve them until a working methodology is achieved. Despite all the challenges, the adaptations learned at this center can be applied to other local hospitals around the world to set up a lower extremity reconstruction practice and improve its outcomes.

scholarly journals Role of Anterolateral Thigh Flaps in Distal Lower Extremity Reconstruction: Assessment of Functionality, Aesthetics, and Patient Satisfaction

2017 ◽  
Vol 02 (02) ◽  
pp. e83-e89
Author(s):  
Michael Trostler ◽  
Johnathan Shih ◽  
Gabriel Klein ◽  
Alexander Dagum ◽  
Duc Bui ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lower Extremity ◽  
Traumatic Injury ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Custom Made ◽  
Reconstructive Option ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
Anterolateral Thigh Flaps

Background Distal lower extremity reconstruction presents many challenges due to the suboptimal vascular supply, the weight-bearing necessity, movement, and multiple tissue types that can be easily damaged by trauma, from bones, tendons, ligaments, muscle, and soft tissue loss. The anterolateral thigh flap provides a reconstructive option for large defects with good coverage and minimal donor-site morbidity. Methods After a chart review of all anterolateral thigh flaps, the patients were contacted to take a survey regarding their satisfaction and functional ability and to meet for measurements of their feet after debulking procedures. Results A total of 13 patients were included in the study, with traumatic injuries comprising 84% of cases. There was a significant difference in sizes of the midfoot (mean: 10.27 vs. 9.53, p = 0.004) and the hindfoot (mean: 12.92 vs. 12.2, p = 0.023) when comparing the affected side to the unaffected side. The majority, 77%, of our patients underwent debulking procedures. Overall, 75% of traumatic injury patients had > 90% maximum functionality score. All posttraumatic reconstruction results were rated satisfied to very satisfied by the patients. All posttraumatic patients were able to walk after their procedures, although three patients did require custom-made shoes with inserts or braces. Conclusion The anterolateral thigh flap is a versatile reconstructive option that can be used in the distal lower extremity and is especially useful after a traumatic injury as it allows for functional recovery and high patient satisfaction after debulking.

Preserving the Blood Flow of the Recipient Artery in Cross-Leg Free Flap Procedure for Lower Extremity Reconstruction

2020 ◽  
Vol 19 (3) ◽  
pp. 255-261 ◽  
Author(s):  
Zulfukar Ulas Bali ◽  
Berrak Karatan ◽  
Yavuz Tuluy ◽  
Yavuz Kececi ◽  
Levent Yoleri
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Free Flaps ◽  
Posterior Tibial Artery ◽  
Anterolateral Thigh Flap ◽  
Recipient Artery ◽  
Anterolateral Thigh ◽  
Thoracodorsal Artery ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction

When there is no suitable vessel in the injured leg for microsurgical transfer, cross-leg free flaps can be considered for lower extremity reconstruction. This report describes patients who experienced lower extremity trauma and underwent reconstruction with cross-leg free flaps with preserved blood flow in the recipient artery. Anterolateral thigh flap is preferred for small to moderate defects. The descending branch of the lateral femoral circumflex artery was dissected 2 cm proximally and distally and was prepared in a T-shape. The branches of the T were anastomosed to the recipient artery in the contralateral leg in the first session of the cross-leg free flap procedure. After 3 weeks, the flap artery was separated from the bifurcation. For large defects, the latissimus dorsi flap was chosen. The thoracodorsal artery was anastomosed to the contralateral posterior tibial artery in the first session. After 3 weeks, to provide recipient vessel integrity, the thoracodorsal artery was transected from the flap and anastomosed to the distal stump of the posterior tibial artery. Between January 2017 and January 2019, 8 defects were reconstructed using an anterolateral thigh flap; the remaining 4 defects were reconstructed using a latissimus dorsi flap. All flaps survived without complications. Anterograde flow distal to the anastomosis was confirmed in all recipient arteries via Doppler ultrasound. In cross-leg free flaps, the continuity of the recipient artery can be established to prevent diminished blood flow to the recipient extremity.

Skin Paddles Improve Muscle Flap Salvage Rates After Microvascular Compromise in Lower Extremity Reconstruction

2018 ◽  
Vol 81 (1) ◽  
pp. 68-70
Author(s):  
John T. Stranix ◽  
Adam Jacoby ◽  
Z-Hye Lee ◽  
Lavinia Anzai ◽  
Pierre B. Saadeh ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Muscle Flap ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction
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