De-epithelialised fasciocutaneous turnover flap: An alternative for defects in lower thigh and knee joint (original) (raw)
Related papers
Inferiorly based thigh flap for reconstruction of defects around the knee joint
Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons of India, 2014
Soft-tissue defects around the knees are common in injured limbs and in the same injury the leg is often involved and the thigh is spared. Furthermore due to pliable and relatively lax skin, we have used inferiorly based thigh flap to reconstruct defects around knee joint. The aim of this study is to evaluate the use of inferiorly based thigh flap to cover soft-tissue defects over the proximal one-third of the leg, patellar region, knee, and lower thigh. This study was conducted during the period between October 2011 and February 2013. Inferiorly based anteromedial thigh fasciocutaneous flap was performed on 12 patients and inferiorly based anterolateral thigh fasciocutaneous flap on four patients. The sites of the soft-tissue defects included patellar regions, infrapatellar region, upper one-third of leg, lower thigh, and over the knee joint. Patients were evaluated post-operatively in terms of viability of flap, the matching of the flap with the recipient site, and donor site morb...
The Anterolateral Thigh Perforator Flap for Reconstruction of Knee Defects
Annals of Plastic Surgery, 2012
Introduction: Large defects around the knee remain challenging reconstructive problems. We report our experience with the use of the anterolateral thigh perforator flap for various defects in this area, based on the anatomy seen intraoperatively. Methods and Materials: Eight knee defects were reconstructed with the anterolateral thigh flap in accordance with our algorithm. Of them, 6 were performed as pedicled flaps and 2 as free flaps. For the pedicled flaps, 1 patient was reconstructed with an anterolateral thigh rotation flap, 3 patients with a directly transposed distally based anterolateral thigh flap, 2 patients with a ''propeller'' distally based anterolateral thigh flap. In the 2 patients reconstructed with the free anterolateral thigh flaps, the intramuscular part of the descending branch of the lateral circumflex femoral artery was used as the recipient vessel. Results: Reconstruction was successfully performed in all patients. Defects limited to the patella and above can be covered by antegrade anterolateral thigh rotation flaps. For larger defects, the distally based flap is needed. This can be used in cases where the perforators arise from the descending branch of the lateral circumflex femoral artery, either as a direct advancement or propeller flaps. In cases where the perforators are not usable or arises from the oblique branch of the lateral circumflex femoral artery, reconstruction was completed as a free flap. In such instances, the distal descending branch provides a reliable recipient vessel. Conclusion: The anterolateral thigh flap offers a versatile and reliable option for defects around the knee. Its use requires a certain degree of reconstructive flexibility as the anatomic variations of the flap may require the flap to be transferred as a free flap in some cases.
Surgical defect reconstructions in knee, lower leg, and foot with flaps: a retrospective analysis
European Journal of Plastic Surgery
Background The first description of local fascio-cutaneous flaps used for the coverage of soft tissue defects of the limbs originates from the 1980s. Over the years, this technique has advanced, and in the meantime, a sub-group of flaps named perforator-based propeller flaps has gained increased attention. In our study, we aimed to demonstrate our experience of operating surgeries with perforator-based propeller flaps and to compare this technique with other flap techniques, which are to reconstruct tissue defects of the knee, lower leg, and foot. Methods A systematic retrospective search for flap procedures for defect reconstructions in the knee, lower leg, and foot from our database was performed. All data between January 2010 and August 2018 were considered. We identified 56 procedures performed on 14 female and 42 male patients with the mean age of 54.13 years. Reconstruction procedures consisted of 34 free flaps, 14 perforator-based propeller flaps, and eight other perforator-b...
FLAP COVER OPTIONS FOR KNEE SOFT TISSUE DEFECTS – AN INSTITUTIONAL EXPERIENCE
Aim: To analyze the demography, presentation, surgical reconstructive options of soft tissue defects over knee and evaluate the complications thereby formulating working protocol for flap options. Materials and methods: Among fifteen patients treated from August 2016 to November 2017, taken into the retrospective study , sixteen knee defects were reconstructed with various flaps. Demography, presentation, flap options ,Outcomes and complications were analysed to formulate the protocol for knee reconstruction. Results: A total of 15 patients with age ranging from 27 ? 65 years (median 42 years) with male dominance ( ratio 14:1) who had treated with flaps for knee defects were included in the retrospective study. Trauma was the commonest causative factor of knee defects in 14 cases. Exposed implant[3] was the second most common etiology. We have reconstructed the knee defects with the gastrocnemius [2,6] and vastus lateralis muscle flaps [4], lateral superior genicular artery perforator flap [1], reverse anterolateral thigh flap [5,6] and saphenous flap. We encountered complications in two patients; 1. Wound dehiscence in Gastrocnemius muscle flap which was conservatively managed subsequently. 2. flap failure in Vastus lateralis muscle which was covered with saphenous flap. Conclusion: With proper preoperative planning and by identifying the problems and requirements, we can do excellent durable coverage of the knee defects with high success rate.
Scholars Research Publisher , 2021
Original Research Article Introduction: A high pace of urbanization and improvised high-velocity motor vehicles are the leading factors for high energy lower limbs trauma in a middle-income country, Bangladesh resulting in a common compound fracture and dislocation at the level of knee; the proximal and middle third of the leg in the salvageable limb. Among the coverage options, gastrocnemius muscle flap (GMF) and proximally based sural fasciocutaneous flap (PBSFC flap) were used for a long period to meet the good reconstructive goals. Aims and objectives: The study aims to compare between gastrocnemius muscle flaps and proximally based sural artery fasciocutaneous flaps for coverage of soft tissue defect on proximal and middle third of leg with the exposed tibia and/or knee joint in terms of operating time, flap viability and its complications, donor site morbidity, time taken for bone healing. Methods and materials: This study is a retrospective study of 22 cases of those who came with soft tissue defects on knee and proximal and middle third of leg requiring flap coverage in Rajshahi Medical College Hospital from August 2019 to July 2021. Here we harvested medial gastrocnemius muscle flap for coverage of knee and proximal third of the leg and PBSFC flap based on median sural artery was done for the defect on knee to proximal two third of leg. All the donor sites of PBSFC flaps were covered by split thickness skin graft, whereas, in case of GMF, the donor site was tried for direct closure. Results and discussion: 13 GMF and 09 PBSFC flap were done in the study period. All collected data were analyzed in GMF group and PBSFC flap group and made the comparison between two groups by standardized analytic testing tools. Conclusion: In comparisons of two different flaps of the study, none was superior in terms of survivability of the flap, rate wound infection control, bone healing.
Cadaveric study and clinical application of turnover fascial flap for lower-limb defects
European Journal of Plastic Surgery
Moderately sized defects of various etiologies are encountered frequently in the lower limb. Several reconstructive modalities are available. Majority of them do not meet all the desirable criterion of recipient and donor site. In a search for an optimal procedure, the fascial flap emerged. We found the fascial flap to be suitable and advantageous for many defects. This paper describes the anatomical basis, planning, technique, and application of the fascial flap. To establish the technique, we divided the study in to two parts (a) cadaveric dissection and (b) clinical application. Dissection in 12 fresh cadaver limbs confirmed the location of the perforators of the posterior tibial and peroneal vessels. It also visualised the rich vascular network associated on either side of the deep fascia. The findings also suggested the safe dimension of a retrograde flap which is the key to success. Convinced and encouraged with the above findings, fascial flaps were successfully used for moderately sized defects at various non-weight-bearing areas of lower limb in 20 patients. Out of these, eight were random flaps and 12 were pre-Dopplered perforator flaps. Out of 20, 16 flaps healed uneventfully. In four cases one had complete necrosis while another had partial necrosis. Two cases had complete graft loss although the flap survived. These cases were followed up from 6 months to 2.5 years with an average of 1.5 years. Fascial flaps provide gratifying results in the majority of moderately sized lower-limb defects in non-weight-bearing areas. It meets most of the requirements of reconstruction in a single stage. Therefore, wherever feasible this simple method is justified.
Annals of Plastic Surgery, 2004
The goal of soft tissue reconstruction in the lower extremities is to provide a functional and cosmetically acceptable limb. The anterolateral thigh flap has become one of the most popular options for soft tissue defect reconstruction recently because of the large amount of skin available and the reliable and versatile nature of this material. The purpose of this article is to present our experiences with the free anterolateral thigh flap for the reconstruction of soft tissue defects of the lower extremity. From April 2002 to October 2003, 31 consecutive free anterolateral thigh flaps were used. There were 24 male and 7 female patients, and their ages were between 3 and 78 years. The size of the flaps ranged from 11 to 34 cm long and 6 to 16 cm wide. In 9 patients, the flaps were harvested in a flow-through manner to both reconstruct soft tissue defects and protect and maintain the vascular status of the lower extremities. In these patients, the pedicle was interposed between vascular gaps, either present or created, in the extremity. The patency of distal anastomosis with the course of the distal vessel was confirmed by using conventional Doppler flow monitoring in flow-through flaps. In 4 cases, thinning of the flap was performed. In 3 patients, flaps were used in a neurosensorial fashion. Four flaps required reoperation due to vascular compromises. While 3 of these were salvaged, 1 flap was lost due to recipient arterial problems. Sixteen cases underwent split-thickness skin grafting of the donor site. No infection or hematomas were observed. We conclude that the anterolateral thigh flap is an ideal and versatile material, especially for lower extremity reconstructions, with its functional and cosmetic advantages, and it can be considered a suitable alternative to the most commonly used conventional soft tissue flaps.
The Egyptian Journal of Hospital Medicine, 2019
Introduction: perineoscrotal defects represent a challenging problem in reconstructive surgery. Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumor excision, burns, etc. There are many techniques described in the literature for reconstruction of defects of scrotal skin. The pedicled medial thigh (PMT) perforator flap is a valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports. Objective: the purpose of this study was to describe clinical applications of the pedicled medial thigh (PMT) perforator flap for reconstruction of loco-regional soft tissue defects. Patients and Methods: between June 2018 and June 2019, an experimental cadaveric study including two cadavers with four lower limbs was done in Al-Azhar University, Faculty of Medicine, Department of Anatomy and Embryology. A prospective cross-sectional study in which ten male patients with soft tissue defects or lesions that requires excision and reconstruction in perineum and scrotum received MTP flaps. All flaps were unilateral and the flap sizes ranged from 9-12 cm to 12-26 cm. Results: all flaps survived well, with the exception of partial wound dehiscence in two patients that was managed conservatively by frequent dressings and healed by 2ry intention. Conclusion: the medial thigh fasciocutaneous perforator flap offers a good option for Perineoscrotal defects. The flap provides a single stage, stable, well vascularized soft tissue coverage with no significant major complications, short hospital stay, appropriate range of motion, faster return to normal lifestyle and accepted aesthetic appearance.
Clinics in surgery, 2020
Background: The lateral thigh flap is a versatile flap that provides many advantages over other free flaps. It has become a mainstay in soft tissue reconstruction of defects in the head and neck, upper and lower extremities. We present our experience with perforator based free lateral thigh flap in a tertiary care center. Method: A retrospective cross sectional analysis of cases done by a single surgeon over a period of 5 years from 1998 to 2003. Those patients were included in the study in which free lateral thigh was done for extremity defects only; flaps done for head and neck reconstruction were excluded. The data of these patients were collected from the medical records and variables included demographic data, mechanism of injury, site and size of defect, pattern of vascularity, complications and flap survival. Data analysis was done by using SPSS version 25.0. Results: We treated 8 patients with lateral thigh flap. All patients were male with a mean age of 28 ± 13 years (ranged from 16 to 55 years). The mean defect size was 25 cm × 15 cm (ranged from 20 cm × 12 cm to 30 cm × 15 cm). Flap tip necrosis was seen in 2 patients while 6 cases (75%) had no complications with 100% flap success rate. The mean follow-up time was 226 months, without significant morbidity at the donor site. The donor site was covered with a spilt thickness skin graft. Conclusion: Our study has concluded that perforator based free lateral thigh flap is safe and reliable for reconstruction of complex and large soft tissue defects in the extremities, that provides excellent, robust skin coverage. It has the added advantage of minimal donor site morbidity. This flap is ideally suited for defects where the recipient vessel is located in the center of defect.