Osteo-myocutanoeus flap: a novel flap for single toe amputation (original) (raw)
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JSCR Journal of Surgical Case Reports
2016
Amputation is frequently required to treat wet gangrene secondary to peripheral vascular disease. Although different types of amputations have been reported, limited digital and ray amputation are the commonest amputations performed. The level of amputation will be determined by the distribution of lower limb disease but for every patient a balance between limb and functional preservation at lower levels versus better wound healing at higher levels should be sought. In this article we describe the novel osteo-myocutaneous flap, which we have used in our patient. We believe that this flap results in improved wound healing and although it results in loss of two digits, it does not impair function.
Treatment of open wounds of the leg by using local flaps
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015
Introduction: Until the 70s, repairing loss of tissue in the leg was almost always difficult, or even impossible. Currently, only the most experienced surgeons are able to repair open wounds of the leg. Nevertheless, several reliable and simple techniques are currently available. This work aimed to evaluate repair techniques for leg wounds by using local tissues. Method: The authors performed a retrospective study of cases of leg reconstruction using local flaps. Dermoadipose, fasciocutaneous, fasciosubcutaneous, and muscle flaps were used. Results: Seventy patients who had open areas in the leg due to tibial fractures, osteomyelitis, ischemic tissue loss, chronic ulcer, or skin tumor underwent surgery. Results were evaluated according to etiology, type of surgical procedure, and complications. Conclusions: The option of treating open wounds of the lower limbs by using local flaps is very valid. Selection of the flap type depended on local conditions in the leg, and the anatomical region affected. In the upper third of the leg, we used fasciocutaneous flaps, based on the vascular network of the knee, or gastrocnemius flaps. In the middle third of the leg, we used the soleus muscle as the primary flap, and fasciosubcutaneous flaps in the calf region. In the lower third of the leg, a fasciosubcutaneous flap of the calf was primarily used.
Diabetic Foot & Ankle, 2011
The authors present their experience with the use of sural fasciocutaneous flaps for the treatment of various soft tissue defects in the lower limb. This paper is a review of these flaps carried out between 2003 and 2008. The series consists of 16 patients, 12 men and 4 women with an average age of 40 years (17Á81) and with a follow-up period between 1 and 8 years. The etiology was major velocity accident in six cases, diabetes mellitus with osteomyelitis after ORIF for fractures (3), work accident in five, and another two cases with complications of lower limb injuries. The defect areas were located on calcaneus, malleolar area, tarsal area and lower tibia. Associated risk factors in the patients for the flap performance were diabetes (five patients) and cigarette smoking (eleven patients).
Cureus, 2022
The resurgence of opiate and intravenous drugs abuse in the United States has presented a renewed challenge to surgeons in community-based hospital settings. Patients often present with complex wounds, and when complicated by concomitant osteomyelitis, these wounds require special attention and diligent care. Local rotational flaps have been used in the salvage therapy of limb-threatening lower extremity trauma for years, and have been adapted in part for the use in patients with chronic, limb-threatening osteomyelitis. The use of local rotational flaps for coverage of chronic osteomyelitis is a viable, proven, and well-founded surgical technique with excellent results. Within our hospital setting, we have seen an explosion of patients presenting with chronic, limb-threatening wounds related to intravenous and subcutaneous injection of a variety of illicit drugs. Here, we describe a case of a 24-year-old female with a history of intravenous drug abuse (IVDA) who presented with an extensive left lower extremity wound which had been progressing for several years. The patient was acutely intoxicated but otherwise healthy. Due to extensive tissue loss and osteomyelitis, initial evaluation deemed her leg unsalvageable. However, given the immense morbidity associated with lower extremity amputation the plastic surgery team felt that salvage should be attempted in this young woman. She underwent numerous tissue debridements, washouts, cadaveric skin grafting, and a pedicled soleus muscle flap with eventual autologous skin grafting. The patient was kept in the hospital during this time to allow her to detox and undergo psychiatric evaluation and therapy. This approach allowed her to regain nearly full use of her limb, gain employment, as well as abstain from further drug use. As the opioid epidemic continues in inner cities throughout the United States, the increased burden on local medical centers to care for chronic limb-threatening wounds will continue to rise. Locoregional flaps provide good results but may not be suitable for unreliable patients struggling with addiction. However, in motivated patients, our approach of inpatient detox and delayed reconstruction has shown promising results.
Distal Based Sural Fascio-Cutaneous Flap: A Practical Limb Saviour for Wounds of War and Peace
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2016
OBJECTIVE To determine the effect of mechanism of injury on wound healing, and on the viability and success of distally based sural flap when used for the coverage of defects of lower leg, ankle and foot. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Department of Surgery, Combined Military Hospital, Peshawar and Khariyan, from January 2012 to December 2014. METHODOLOGY Patients with soft tissue defects over the distal leg, ankle and foot were selected by purposive sampling technique and divided into 2 groups of 19 patients each. Group A(road traffic accidents) and group B (war injuries). Sural fascio-cutaneous flap was the reconstructive tool used in all the cases using single technique by the same surgical team; and time for recipient site preparation, size of the defect, graft survival, its healing time and complications, were studied. RESULTS The mean age of the 38 patients in the study was 28.2 ±13.4 years. There were 36 male and 2 female patients. The most common...