APPLICATION OF PEDICLE FLAPS FOR WOUND COVERAGE OF LOWER LEG

Abstract

SUMMARY This paper presents 11 clinical cases with soft tissue defect of lower leg and foot. The reconstructive surgery of the wounds involves 14 pedicle flaps: five of which are gastrocnemius; nine are sural flaps. The etiology of the defects is various: 6 of the patients are with deep burns of the lower limbs; 3 with deep frostbite; 2 with different trauma. The patients are aged between 27 and 79. The obtained results and the applied reconstructive methods in the treatment of soft tissue defects of the lower extremities are discussed. During the period 2001-2010 fourteen pedicle flaps were applied in 11 patients. The age of the patiens was between 27 and 79. The cases are: five with deep knee burn; one with burn in both feet, three with frostbite; two with different trauma. The Application of the flap is determined by the size, location and the depth of the defect, regardless of the etiology of the wound. The accompanying diseases are not considered contraindications for treatment with flaps. Five reconstructions were performed with gastrocnemius flap, nine with sural flap. The medial head of gastrocnemius was used in four patients and the lateral head in one. A subcutaneous tunnel at the level above the proximal part of the tibia is formed medially or laterally depending on which muscle head is going to be used. The flap is passed through the subcutaneous tunnel and is spread over the anterior surface of the knee joint. It is fixed to the wound edges by single stitches. The muscle is covered with a split skin graft meshed at a 2:1 ratio. Sural flaps were elevated as a fasciocutaneus flaps, including the neurovessel bundle and strip of deep fascia 2,5cm wide. The dimensions of the smallest sural flap were 6.5 x 7 cm and the measurements of the biggest one were 8 o 10 cm. The donor site was covered with free skin graft. Two cases with frostbite required simultaneous application of two sural flaps to both feet. RESULTS Successful results were observed in 10 (83,33%) cases. Complete tissue coverage and good function of the injured joints and feet were achieved. Partial lesion of the free skin graft was observed in two patients (16,67%) with m. gastrocnemius flap which did not require additional surgery. One (11,11%) complete flap loss of sural flap was observed. After wound granulation, full thickness skin graft was applied and the result was satisfactory. Distal edge necrosis appeared in 4(44, 44%) cases. Two of them were caused by compression of the flap because the patients failed to observe the postop rules. The skin island was lost in two patients who suffered from diabetes. In the last two cases the defects were covered with full skin graft.