Coverage Of Soft Tissue Defects Research Articles

Pedicled thoracoumbilical flap coverage for wounds around elbow: A versatile option

Background: To evaluate the reliability of pedicled thoracoumbilical flap for reconstruction of soft-tissue defects around the elbow. Materials and Methods: This was a prospective study undertaken between September 2017 and November 2018, in division of plastic and reconstructive surgery of our institution. Patients with soft-tissue defect of the elbow referred from the division of orthopedic surgery were included. Those with a scarring in the region of thoracoabdominal flap were excluded. A detailed history and examination were recorded. An informed consent was taken from every patient. Anteroposterior and lateral radiographs of the elbow were taken in all cases. Pedicled thoracoumbilical flaps were raised in all patients for the coverage of soft-tissue defects around elbow. Pedicle division and final inset were done after 4 weeks in all cases. All patients were followed up regularly. Results: A total of 5 patients with soft-tissue defect around the elbow were referred to our division from the division of orthopedic surgery. All patients were male with a mean age of 33 ± 6.67 years (25–40 years). The injuries were common in labor class, and the most common etiology being fall from height in three out of five cases. The right elbow was often injured (three out of five cases). In all patients, the wounds were of Gustilo Anderson grade IIIB. In one case, the implant was exposed (case 3). The mean defect size was 45.75 ± 6.29 cm2, and the mean flap size was 171.85 ± 13.12 cm2. No complications were seen in our case series. Conclusion: The pedicled thoraco-umbilical flap is technically simple and versatile option for the coverage of soft-tissue defect around elbow since it is vascularity is predictable.

Fournier's gangrene: a review of reconstructive options.

IntroductionFournier’s gangrene is a rapidly progressive necrotizing fasciitis of the genital and perineal tissues with a high mortality rate. Early diagnosis and treatment with fluid resuscitation, surgical debridement and wide-spectrum antibiotics are essential in the management of Fournier’s gangrene. After primary treatment, reconstructive surgery is often necessary for coverage of soft-tissue defects. This review article aims to provide an overview of the main reconstructive procedures used in Fournier’s gangrene.Material and methodsA literature search was performed on the subject of reconstructive surgery in Fournier’s gangrene.ResultsTechniques of reconstructive surgery for soft-tissue defects following Fournier’s gangrene include skin grafts, local advancement flaps, scrotal flaps, multiple fasciocutaneous and myocutaneous flaps, and testicular transposition. The surgical goal is to achieve the best functional and cosmetic result possible with minimal morbidity. Advantages and disadvantages of each technique and potential indications are discussed.ConclusionsCharacteristics of the defect, patient preference and surgeon experience should guide the choice of reconstructive procedure. Further comparative studies are needed to optimize results.

Use of the Keystone Perforator Island Flap in the treatment of chronic lower extremity wounds complicated by osteomyelitis

IntroductionReconstruction of chronic lower extremity wounds can be especially challenging when these wounds are complicated by osteomyelitis. They require the joint expertise of plastic and orthopaedic surgeons. MethodsWe report our experience using the Keystone Perforator Island Flap following wound and bone debridement as a valuable surgical tool for coverage of complex wounds with bone infection. ResultsTwelve patients underwent similar procedures with overall good outcomes, although two patients experienced a complication, specifically partial flap necrosis and wound dehiscence subsequent to recurrent osteomyelitis. We also reviewed the underlying physiological mechanisms of employing the Keystone flap in order to demonstrate its advantages and efficacy. ConclusionOur results confirm that the Keystone flap can be a safe, reliable and effective method for coverage of soft tissue defects and the preservation of bone integrity in the management of patients with chronic osteomyelitis.

Free perforator flaps vs propeller flaps in lower limb reconstruction: A cost/effectiveness analysis on a series of 179 cases

PurposeThe aim of this report is to compare free perforator flaps and propeller flaps in the coverage of lower limb soft tissue defects. Patients and methods179 patients (age between 5 and 92 years old), underwent soft tissue reconstruction of the lower limb between January 2009 and January 2015, either by free flap or propeller flap. The two groups were retrospectively evaluated in order to assess the outcome, complications and potential risk factors. Correlations between risk factors and presence/absence of failure or complications have been evaluated with descriptive statistical analysis and a set of logistic regression models. Finally, an economic analysis was conducted to evaluate the different tecniques. ResultsIn a simple descriptive statistical analysis, the overall failure rate is 6% for free flaps and 3.7% for propeller flaps; the complication rates are 14% vs 21.5% and it increases as dimension increases. The logistic models relating failure and complications with potential risk factors do not show significant differences, whereas the economic analysis show that the average expense of free flaps is 5077.5€ per patient, 1595.6€ per patient for propeller flaps. ConclusionsOur results do not demonstrate significant differences between the two groups about correlation of risk factors or flap size with complication or failure. The surgical option choice should be taken only after accurate evaluation of the soft tissue surrounding the defect. Propeller flaps should be preferred in case of small/medium size defects in otherwise healthy extremities. Free perforator flaps should be the choice in large defects due to trauma or vascular diseases. The economic analysis suggests that propeller flap should be considered when possible.

The Holevich modification of the first dorsal metacarpal artery flap in coverage of thumb skin losses

<p class="abstract"><strong>Background:</strong> Reconstruction of complex soft tissue defects of the thumb is a challenging problem. It is very important to reconstruct these defects using sensate flaps as the thumb pulp needs to be sensate for implementing the various functions of the thumb. The aim of this study is to report our experience on the safety and functional outcome of the innervated first dorsal metacarpal artery flap (FDMA) for soft tissue defects of thumb.</p><p class="abstract"><strong>Methods:</strong> During 18 month period, nine patients with a mean age of 29 years, male:female ratio of 8:1 underwent coverage of soft tissue defects of the thumb, of various volar and dorsal defects, using an innervated first dorsal metacarpal artery flap. Indications were postburn deformities and acute trauma. None of the patients had any neurorraphy. Outcome of the Holevich modification of FDMA flap was assessed with regards to survival and function, reachability for different locations of the thumb, recovery of sensation in terms of two-point discrimination (2PD), donor morbidity with regards to deformity and range of motion were analysed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean size of the defect was 6.7 cm<sup>2</sup>. Average hospital stay was 5 days. Average time of sensory recovery was 6 months. The mean 2PD was 4 mm (range 2-6 mm). All patients had a normal active range of motion in the donor finger. One of nine patients had distal flap marginal necrosis of 3-4 mm; it healed with debridement and regular dressings over 12 days.</p><p class="abstract"><strong>Conclusions:</strong> The Holevich modification ensures the safety of the innervated FDMA flap in thumb defect coverage with good recovery of sensation.</p>

Selecting a free flap for soft tissue coverage in lower extremity reconstruction

BackgroundGoals of lower extremity microvascular reconstruction (LEMR) include the restoration of function, prevention of infection, and optimal cosmesis. Indications for LEMR include large defects that are not amenable to pedicled options, a large zone of injury, and large complex defects. The novice microsurgeon should first master a handful of free flaps to develop an armamentarium of options for addressing such defects. The scope of this review is to provide free flap options for LEMR in any of the thirds of the lower leg. After reading this article, the reader will understand variations, advantages, disadvantages, indications, and tips for raising each of these flaps. MethodsSix most commonly used free flaps for LEMR are described in this paper, including the anterolateral thigh flap (ALT) and its variations, the radial forearm flap (RFFF), the lateral arm flap (LAF), the gracilis muscle flap, the rectus abdominis flap (RAF) and the latissimus dorsi flap and its variations. Indications, advantages, disadvantages and technique tips are discussed for each flap. Moreover, selection of the recipient vessels, preoperative management along with an algorithm are also provided. ConclusionsThe ALT flap is a workhorse in covering defects of the leg, foot, and ankle. It's the flap of choice at our institution, especially given the number of traumatic wounds seen as a result of motor vehicles, all-terrain vehicles (ATV), lawnmowers, and gunshot wounds (GSW). At times, the lower extremity zone of injury requires a distant donor site. The RAF can also provide coverage for large soft tissue defects but donor-site morbidity remains its main drawback. The LAF and RFFF provide two pliable options, one that provides pliable soft tissue with minimal donor site morbidity and another that provides a long pedicle. The free gracilis flap is an excellent choice for crossing the ankle joint. Lastly, the free latissimus dorsi is indicated for large defects of the lower extremity independently of the location.

Rectus abdominis free tissue transfer in lower extremity reconstruction: Long term follow up in 58 cases

This study evaluates the long-term results of rectus abdominis free-tissue transfer performed for lower extremity reconstruction. MethodsOver a period of 8 years 58 were available for long term follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. ResultsAt a mean follow-up of 18 years, there were no major complications in the soft tissue defect coverage group except for one patient who continued to have recurrent folliculitis over the weight bearing heel area, which was treated by repeated debridement. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. ConclusionsThe rectus abdominis free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis

Reverse sural flap – A feasible option for oncological defects of the lower extremity, ankle, and foot: Our experience from Northeast India

Background:Soft-tissue management around the lower third of the leg and foot presents a challenge to the surgeon. To achieve local control of tumor, additional surgical margins are required, thus creating large soft-tissue defects. The reverse sural artery flap (RSAF) is a popular option for many of these defects.Materials and Methods:This is a retrospective study of 26 patients who underwent resection of tumor around the lower leg, ankle, and foot, and reconstruction with RSAF was performed at our institute from 2012 to 2018.Results:Among the 26 studied patients, aged between 22 and 71 (mean age: 50.8) years, 5 were female and rest were male. The most common site of involvement by tumor was heel (42.3%), followed by sole (26.9%). The most common histopathological diagnosis was melanoma (61.5%), followed by squamous cell carcinoma (26.9%) and soft-tissue sarcoma (11.5%).Conclusion:The distally based sural flap is a reliable flap for the coverage of soft-tissue defects following oncological defects of the distal lower extremity and foot.

Customized reconstruction of complex soft-tissue defect in the hand and forearm with individual design of chain-linked bilateral anterolateral thigh perforator flaps

Complex soft-tissue defects of upper extremities still have a high rate of amputation, as the reconstruction of complex soft-tissue defects is always difficult even with the largest conventional free flap. The anterolateral thigh perforator (ALTP) flap is one of the most popular procedures used for the coverage of complex soft-tissue defects of extremities. However, problems associated with donor-site morbidity and inability to repair complex soft-tissue defects in a one-stage procedure persist. The purpose of this study was to present a novel design of using chain-linked bilateral ALTP flap and its various designs for customized reconstruction of complex soft-tissue defects in the hands and forearms. From June 2009 to June 2017, we retrospectively analyzed 15 patients with complex soft-tissue defects in the hands and forearms. All patients in this series underwent extremity reconstruction using the chain-linked bilateral ALTP flaps. Three different types of chain-linked bilateral ALTP flaps were created in this study based on wound characteristics and the maximum available skin paddle size at all donor sites. The chain-linked bilateral ALTP flaps were successfully harvested for the reconstruction of complex soft-tissue defects in the hands and forearms. Among them, ten cases were repaired with chain-linked bipaddle ALTP flaps, two cases were treated with chain-linked tripaddle ALTP flaps, and the remaining three cases were used with chain-linked multi-lobed ALTP chimeric flaps. The sizes of the skin paddles ranged from 11cm × 7 cm to 42cm × 8cm. The areas of the total flaps ranged from 245cm2 to 650cm2 (mean 419.6cm2). Only one case required re-exploration because of the venous congestion. The donor sites were closed directly. The mean follow-up time was 16.4 months. Most cases showed satisfactory contour. The chain-linked bilateral ALTP flap is a reliable option for one-stage reconstruction of complex soft-tissue defects in the hands and forearms with limited donor-site morbidity. It also provides various flap designs, which allow for more individualized treatment approaches.

Reversed Hemisoleus Flap for Traumatic Wound Coverage in the Distal Third of the Leg

AbstractBackground: Reconstruction of soft tissue defects of the distal third leg are common challenging therapeutic problems with significant long-term morbidity. Treatment options include cross leg flaps, local flaps (as muscle flaps and fasciocutaneous flaps) and the free vascularized flaps.Aim of Study: The aim of this study is to evaluate the clinical outcome of reversed hemisoleus muscle flap in cov-erage of traumatic soft tissue defects in the distal third of the leg.Patients and Methods: In this prospective study, we present 21 patients with traumatic soft tissue defects in the distal third leg with exposure of bone, tendons and neurovas-cular structures, managed by reversed medial hemisoleus muscle flap. Clinical and radiological data were analyzed.Results: The outcome of the flap surgery was evaluated after at least 6 months follow-up on the basis of flap survival, graft intake, functional gain and donor site morbidity [1]. Clinical results were graded as excellent, good, fair as follows: 13 showed excellent results (61.9%), 7 showed good survival (33.3%) and 1 flap was graded as fair (4.8%) with no poor results. The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Accordingly, satisfactory results were found in 20 patients (95.2%), and the unsatisfactory results were found in 1 patient (4.8%) with reliable soft-tissue cov-erage and complete wound healing in all patients.Conclusion: This study shows that reversed medial hem-isoleus muscle flap is a reliable reconstructive option for traumatic soft tissue defects on the medial side of the distal tibia in selected cases.

Revisiting the Trapezius Flap as a Reconstructive Option for Cervico-Occipital and Thoracic Spine Regions.

Introduction Reconstruction of complex soft tissue defects around the cervico-occipital and thoracic spine regions is a challenging task. We want to share our experience with trapezius flap for the reconstruction of these complex cases. Materials and Methods A retrospective analysis of patients who underwent reconstruction using trapezius flaps from January 2016 to June 2019 was performed. The indications, technique, complications, and outcomes were analyzed and presented. Results Six patients (three males and three females, >10 years of age) underwent seven reconstructions using trapezius flaps (one of the patients underwent reconstruction using a bilateral trapezius flap). Trapezius flap was used to resurface the parieto-occipital ( n = 2), cervico-occipital ( n = 2), cervicothoracic ( n = 1), and thoracic ( n = 1) regions. All flaps showed successful outcomes; one patient had wound dehiscence, and one patient had partial skin graft loss. Conclusion Trapezius flap is a reliable and good alternative to free flaps for the coverage of complex cervical-occipital and upper thoracic soft tissue defects.

Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities

The middle and distal leg coverage is demanding procedure for reconstructive surgeon until evolution of local perforator flaps which becomes as valuable options in lower limb reconstruction. The goal of our study was to assess the results, reliability, safety, and possible complications of the local propeller perforator flaps in lower extremity reconstruction. We demonstrate a case series of 11 patients in whom we cover small-to-medium soft-tissue defects of the middle and distal leg by application of local propeller perforator flaps. The site of soft tissue defects were in the distal third in 9 cases (81.8%) and 2 cases (18.1%) in the middle third. Flap dimensions ranged from 48 to 192cm2, with an average size of 88.9 cm2. The flap rotation was 180 degrees in (63.6%) of cases. The flaps were based on a single perforator of the posterior tibial artery in 8 (72.7%) cases and peroneal artery perforator in 3 (27.2%) cases. Complications were present in 18% of the perforator flaps which were based on peroneal artery perforator, one partial necrosis and one flap with a superfacial epidermolysis. The donor area is covered by split thickness skin graft in 63.6% of our cases and primary closure of in 36.3% of cases. The perforator propeller flaps are safe, relatively simple procedure and consider as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg which provide similar skin texture with low donor site morbidity.

Venous Flaps for Revascularization and Soft-Tissue Coverage in Traumatic Hand Injuries: A Systematic Review of the Literature.

The use of the venous flap for simultaneous revascularization and coverage of soft tissue defects has been documented in the literature for over 30 years. First described in 1981, Nakayama et al demonstrated that a vein and overlying skin, or a venous flap, may be transposed from one area of the body to another with complete survival of the graft. The aim of this study was to conduct a systematic review of the literature to determine predictors of venous flap survival in traumatic hand injuries. A literature search of PubMed, MEDLINE, and Cochrane Library was performed with emphasis on venous flap use in traumatic hand injuries. MeSH terms included: vein graft, revascularization, venous flow through flap, arterialized venous flap, bypass, replantation, amputation, avulsion, trauma, injury, amputate, finger, hand, and thumb. Forty-three articles were collected that contained data on 626 free venous flaps. Most patients were males (73.9) and injured their right hand (52.3%). The forearm was the most commonly used venous flap donor site (83.6%), and most of the skin paddles were 10 to 25 cm2 (41.1%). Arterial inflow was used in 93.1% of the flaps. Most venous flaps (79.6%) healed without superficial tissue loss or necrosis. Ninety-two (14.7%) flaps had partial loss while 36 (5.8%) flaps did not survive. The use of venous flaps for concomitant revascularization and soft tissue coverage of the hand permits good results with limited morbidity. The overall flap survival rate is nearly 95%. Younger patients whose flaps have arterial inflow and skin paddles of medium size (10-25 cm2) have the best chance for survival.

Use of a vascularized dorsal sensory branch of an ulnar nerve flap for repairing a proper digital nerve with coverage of a volar soft tissue defect: Report of two cases

To repair a short nerve gap, autograft, allograft, autogenous, or synthetic conduits are selected, but a vascularized nerve autograft is preferred to obtain a reliable postoperative outcome in the case of an unfavorable wound bed. The purpose of this report is to describe and evaluate two cases of repair of a proper digital nerve and volar soft tissue defect with a vascularized dorsal sensory branch of an ulnar nerve flap. The cases of two men, 40 and 20 years old, who suffered index finger defects due to crush lacerations that required a flap and a nerve graft, are presented. A 4.0 cm × 2.0 cm and a 3.2 cm × 1.6 cm flap, which were nourished by the perforators from the ulnar proper digital artery of the little finger, were elevated from the ulnar side of fifth metacarpal bone head and transferred for coverage of the soft tissue defect. A 4.6-cm and a 3.0-cm vascularized nerve graft was interposed in the nerve gap. The patients' postoperative courses were uneventful, and both patients had no complaints related to the donor site. Static and moving two-point discrimination were 8 and 6 mm, respectively, at 6 months after surgery in the first case and 5 and 3 mm, respectively, at 9 months after surgery in the second case. This flap, which could be elevated in the same operative field with a nerve having similar diameter to that of the proper digital nerve, was useful for repair of a finger volar tissue defect.

Soft Tissue Reconstruction for Deep Defects over a Complicated Total Knee Arthroplasty: A Systematic Review.

Deep soft tissue defects after complicated primary or revision total knee arthroplasty (TKA) can be devastating to the patient and technically challenging. The purpose of this review was to (1) discuss different methods used to provide coverage for deep defects of the knee following TKA, as well as to (2) report on their success rates. A comprehensive literature search was performed. Reports were only included if they (1) were case series, (2) were level III studies or above (including retrospective cohort studies and meta-analyses), (3) were in English, and (4) discussed the outcome of graft or flap coverage of soft tissue defects after total knee arthroplasty. A total of 28 case series and four retrospective comparative studies were retrieved. In 16 studies, 195 out of 241 patients who received gastrocnemius flaps (81%) experienced successful outcomes. In seven studies including 84 patients that underwent fasciocutaneous flap coverage, over 90% of patients experienced successful outcomes. In the four studies examining 144 patients with delayed versus prophylactic soft tissue reconstruction, up to 81% of patients experienced a successful outcome. Various factors must be taken into consideration when assessing full-thickness defects over a TKA and collaboration between plastic and orthopaedic surgeons is required to select the optimal approach.

Outcome of Islanded Gastrocnemius Musculocutaneous Flap in Orthopaedic Practice.

Introduction: Large wounds in the leg require combination of local flaps or free flap for wound coverage. Gastrocnemius musculocutaneous flap (GMCF) allows a large wound to be covered by a single local flap. However, the conventional GMCF is often associated with donor site morbidity where the exposed soleus raphe causes poor uptake of the skin graft. Islanding the skin on the muscles allows the donor site to be closed primarily, thus avoiding the donor site morbidity.Materials and Methods: Medical records of twelve patients who underwent islanded GMCF surgery from 2004 till 2018 were reviewed retrospectively.Results: The mean age was 31 years old. Eight cases were with open fracture of the tibia, two degloving injury exposing the patella, one open fracture of patella and necrotising soft tissue infection. The wound size ranged from 12cm2 to 120cm2. All flaps survived. Three patients required skin grafting at the donor site while in the rest the donor sites were able to be closed primarily. Four patients developed deep infection, one healed after vacuum dressing, one after bone transport and one after split thickness skin graft. One patient ended up with below knee amputation after developing chronic osteomyelitis of the tibia.Conclusion: Islanded gastrocnemius musculocutaneous flap is an effective simple alternative for coverage of large soft tissue defects from the knee to half of the leg distally with minimal donor site morbidity. Aggressive debridement of unhealthy tissue is necessary to prevent infection following wound coverage with this flap.

Eradication of Acinetobacter baumannii/Enterobacter cloacae complex in an open proximal tibial fracture and closed drop foot correction with a multidisciplinary approach using the Taylor Spatial Frame\xae: a case report

BackgroundMulti-drug-resistant bacteria (e.g. Carbapenem-resistant Acinetobacter baumannii, extended-spectrum betalactamase or carbapenemase-producing enterobacteriaceae) are emerging in early-onset infections. So far, there is no report describing the eradication of these bacteria in a osseous infection of an open proximal tibial fracture in combination with the hexapod technology to address both osseous consolidation and closed drop foot correction.Case presentationAfter sustaining a proximal tibial fracture (Gustilo 3B), a 41-year-old man was primarily treated with open reduction and internal fixation by a locking plate and split-thickness skin graft in the home country. At the time of admission to our hospital there was a significant anterolateral soft tissue defect covered with an already-necrotic split-thickness graft and suspicious secretion. CAT and MRI scans revealed no signs of osseous healing, intramedullary distinctive osteomyelitis, as well as a large abscess zone in the dorsal compartment. Multiple wound smears showed multi-drug-resistant bacteria: Acinetobacter baumannii (Carbapenem resistant) as well as Enterobacter cloacae complex (AmpC overexpression). After implant removal, excessive osseous and intramedullary debridements using the Reamer Irrigator Aspirator (RIA®) as well as initial negative pressure wound therapy were performed. Colistin hand-modelled chains and sticks were applied topically as well as an adjusted systemic antibiotic scheme was applied. After repetitive surgical interventions, the smears showed bacterial eradication and the patient underwent soft tissue reconstruction with a free vascularized latissimus dorsi muscle flap. External fixation was converted to a hexapod fixator (TSF®) to correct primary varus displacement, axial assignment and secure osseous healing. A second ring was mounted to address the fixed drop foot in a closed fashion without further intervention. At final follow-up, 12 months after trauma, the patient showed good functional recovery with osseous healing, intact soft tissue with satisfactory cosmetics and no signs of reinfection.ConclusionsA multidisciplinary approach with orthopaedic surgeons for debridement, planning and establishing osseous and joint correction and consolidation, plastic surgeons for microvascular muscle flaps for soft tissue defect coverage as well as clinical microbiologists for the optimized anti-infective treatment is essential in these challenging rare cases.Level of evidenceLevel IV.

The versatile use of fasciocutaneous flaps in coverage of extensive soft tissue defects

<br><b>Background:</b> Coverage of large soft tissue defects has always been difficult. Despite an increase in free flap options and many of combinations, it is still a big problem to repair large defects in some patients. In this study, repair of large defects with random fasciocutaneous flaps prepared from adjacent regions to the defect has been evaluated in functional and esthetic terms, especially in cases where microsurgery methods cannot be implemented or do not suffice. <b>Patients and Methods:</b> Ten patients' large soft tissue defects in different regions were repaired with random fasciocutaneous flaps. Average defect size was 15.2 cm × 18.3 cm, and defects were covered with random flaps with an average size of 14.8 cm × 28.1 cm. Average operation duration and average hospital stay were measured at 2.7 h and 2.2 days, respectively. <b>Results:</b> Patients were followed for 6 months on average. Complications such as flap loss, bleeding, or infection were not encountered in any patient at an early or late stages. Recovery of donor sites was evaluated unproblematic, and esthetic appearance was regarded acceptable. <b>Conclusion:</b> Fasciocutaneous flaps neighboring the defect can be prepared in larger dimensions compared to their alternatives, and they can cover the defect with less problems. Producing quite successful results is highly possible, especially in cases where the use of free and axial flaps is inappropriate. With the rapid development in microsurgery, many flap alternatives have emerged for the coverage of basic or complicated defects. However, random fasciocutaneous flaps have to be kept in mind as they are more basic and often have the potential to produce better and more effective results than these methods.<br>

Perforator pedicled propeller flap: A reliable coverage of wounds around ankle

Background: This study aimed to determine the reliability of perforator pedicled propeller flap for coverage of wounds around the ankle. Materials and Methods: This was a prospective study undertaken between September 2017 and November 2018 in the Division of Plastic and Reconstructive Surgery of our institution. Patients with soft-tissue defect of the ankle referred from the Division of Orthopedic Surgery were included. Those with a scarring in the region of calf in the area of proposed flap were excluded. A detailed history and examination were recorded. A complete blood count, kidney and liver function tests, coagulation profile, and hepatitis B and C and human immunodeficiency viral marker testing were performed following informed consent. Anteroposterior and lateral radiographs of the ankle were taken in all cases. Perforator pedicled propeller flaps were raised in all patients for coverage of soft-tissue defects around the ankle. All patients were followed up regularly. Results: Ten patients with soft-tissue defect around the ankle were referred to our division from the Division of Orthopedic Surgery or admitted through the outpatient department of the Division of Plastic and Reconstructive Surgery of our institution. Eight patients were male and two were female, with the age ranging from 10 to 50 years. The mean operation time was 58 min. Size of the flap varied from 21 cm × 8 cm (168 cm2) to 8 cm × 5 cm (40 cm2). Flaps were rotated through 110°–180°. Out of ten flaps, eight flaps survived completely without any complications. Partial flap loss was found in one patient (10%), marginal flap necrosis in one patient (10%), and none of the flap was lost completely. Thus, the overall success rate of perforator pedicled propeller flap in our study observed was 80%. Conclusion: The perforator-based propeller flap is a versatile and reliable flap for the coverage of soft-tissue defects around the ankle because its vascularity is predictable.

A Modification in the Shape of the Skin Island of Fasciocautaneous Flaps in the Distal Extremities

Background: Distally based (reversed flow) fasciocautaneousflaps are used for coverage of distal extremity softtissue defects. However, there is a high incidence of venouscongestion that may lead to partial or total flap loss. Variousmodifications for these flap design have been made aimingto improve flap survival.Aim of Work: In this paper, a tongue like extension fromthe skin island was done aiming to improve its versatility anddecrease complication rate especially venous congestion.Patients and Methods: Eight patients (five males andthree females), average age thirty years old. Most cases wherepost traumatic, one case necrotizing fasciitis of heel, one casewith squamous cell cancer of dorsal hand skin. Five patientsunderwent reversed sural flap and three patients underwentradial forearm flap.Results: All cases had viable flaps with good woundhealing. However female patients complained of the scarringlater on. One case of reversed sural flap had minimal distalcongestion that improved later on.Conclusion: Advantage of this modification is that it actsto stabilize the critical vascular pattern of the pedicle duringits axial rotation minimizing the post insetting vascularproblem. It improves the venous drainage through the subdermaland subcutaneous venous plexuses and limits the excesskinking of the fascial pedicle. This tongue of tissue can alsoserve as an extra tissue to be used for coverage in some cases.It also has a superior cosmetic appearance when compared toskin grafting of the pedicle. The use of this modified techniquecan be extended to any island flap that has to pass through atight tunnel to reach the defect.