Repairing massive soft tissue defects below the knee with combined flaps

Abstract

Objective To explore the clinical value of repairing massive soft tissue defects below the knee with diverse combined flaps. Methods From January 2005 to December 2008, 36 patients with massive soft tissue defects below the knee were treated with combined flaps, including free anterolateral thigh flaps in 14 cases and free latissimus dorsal muscular flaps in 6 cases (both combined with posterior tibial vascular single bridge flaps from the healthy limb), free anterolateral thigh flaps combined with local transferred saphe-nous neurocutaneous vascular flaps in 11 cases, free thoraco-umbilical flaps plus local transferred gastrocnemius muscular flaps in 3 cases, free anterolateral thigh perforator flap plus free thoraco-umbilical flap in 1 case, free anterolateral thigh flap and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibia] vessel from the healthy limb to form vascular pedicles in 1 case. Results In 33 cases, flaps survived completely and their wounds were healed primarily. Vessel exploration was carried out following vascular crisis in 3 cases. After the artery crisis was relieved, the free flap survived well in 1 case, 1 case experienced marginal necrosis because of the arterial thrombosis in and 1 case partial necrosis because of the vein thrombosis. The overall flap success rate was 97.2% (35/36) . Follow-ups for a mean of 16 (4 to 36) months showed that all the flaps survived with good quality and shape and the affected foot and ankle obtained good function. Conclusions It is a feasible and effective method to repair massive soft tissue defects below the knee using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb function and shorten the course of treatment. Key words: Surgical flap; Foot injuries; Ankle injuries; Foot and ankle injuries; Soft tissue injuries