Flap For Soft Tissue Reconstruction Research Articles

Reconstruction of a Wrist Defect with a Distally-Based Radial Artery Perforator Flap: A Case Report

Introduction: Because of the important anatomical structures situated superficially, reconstruction of wrist soft tissue defects is challenging for the plastic surgeon. Depending on the characteristics of the defect, various reconstruction methods are commonly performed. A pedicled perforator flap stands as a valuable option providing reliable coverage of the defect while preserving the vascularity. Case report: A 35-year-old male presented with a post traumatic wrist soft tissue defect with exposure of underlying structures. Surgical debridement was performed, and the resulting defect was reconstructed with a distally-based radial artery pedicled perforator flap. Postoperative recovery was uncomplicated. Conclusion: Radial artery perforator flap proved to be a workhorse flap for soft tissue reconstruction of the wrist. It has many of the benefits of the radial forearm flap but minimizes the disadvantages.

Colgajo fasciocutáneo tipo lengüeta medial como alternativa para el manejo de defectos de tejidos blandos en la pierna

BackgroundSelecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity. ObjectiveDemonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps. Materials and methodsCohort study matched by age. 64 patients with soft tissue defects were selected and according to the intervention divided in: group 1)medial tab flap, and group 2)conventional flaps (sural, soleus, gastrocnemius) followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications. ResultsThe patients who underwent surgery with medial tab flap and with conventional flaps healed completely. The healing time was 16.2±11.2 days in the tab flap and 16.1±11.2 days in conventional flaps, no statistically significant differences were found between the groups (P=.89).The surgical time for tab flaps was 225.2±117.8minutes, and 191.3±117.2minutes for the comparison flaps (P=.65), there were no statistically significant differences. There were no complications in the medial tab flaps. ConclusionThe findings suggest that the medial tab flap technique is as effective as the conventional flap technique, with complete flap survival and healing, and without any major complications in this studied group.

Clinical outcomes of perforator-based propeller flaps versus free flaps in soft tissue reconstruction for lower leg and foot trauma: a retrospective single-centre comparative study.

The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction. We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis. The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases. Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Anatomical Relations of the Perforators from the Descending Lateral Femoral Circumflex Artery and Vastus Lateralis Motor Nerve Branches.

The anterolateral thigh (ALT) flap, which is nourished by perforators from the descending branch of the lateral femoral circumflex artery (P), is one of the most commonly used flaps in soft tissue reconstruction. With the growing use of ALT flaps, attention toward donor-site morbidity has increased in recent years. Damage to the motor nerve branches of the vastus lateralis muscle (N) is one of the causes of donor-site morbidity, particularly muscle weakness. This study investigated the anatomical locations of the P and N in fresh-frozen cadaveric specimens. This study included 43 cadaver limbs. A silicone rubber compound (30 mL) was injected into the femoral artery to visualize the vessel. The locations of the P and motor points of N were measured to assess the risk of N injury during ALT flap harvesting. There were one to six (mean, 2.7) P and two to seven (mean, 4) N. When the two most proximal perforators were used for flap harvesting, an average of 1.5 motor nerve branches (42%) was damaged because transection of the motor nerve branches was required for flap harvesting. In 33% of the limbs, only one motor nerve branch remained after the flap harvest. However, there were no cases where all motor nerve branches were severed. When an ALT flap with two perforators is harvested, weakness of the vastus lateralis muscle may occur in cases with a small number of motor nerve branches.

Algorithm for the reconstruction of the parotid region: a single institution experience

ObjectiveThis study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects.Materials and methodsA retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data.ResultsAmong the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received 125I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases.ConclusionImmediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region.

A PROSPECTIVE COHORT STUDY OF REVERSE PERONEAL ARTERY FLAP FOR LARGE SOFT TISSUE DEFECTS OF THE FOOT IN GMKMCH, SALEM : A RELIABLE COVERAGE

Background: Islanded Reverse Peroneal Artery Flap (RPAF) can be designed as a large regional flap from the popliteal crease. It can be used in single stage. It is based on the anastomosis around ankle joint from posterior and anterior tibial arteries based on the reverse flow to the peroneal artery. It can be used in peripheral centers where microsurgical options not feasible. Methods: Twenty patients with large plantar and dorsal defects of the foot operated for Reverse Peroneal Artery Flap for soft tissue reconstruction over a period of 2 years. All patients were operated in a single stage. Mean age of the patients was 38 years. Results: Of the 20 flaps , all patients showed complete survival without even marginal necrosis. Two patients developed donor site problems settled with conservative management. Conclusion: Reverse peroneal artery flap is a very reliable flap in soft tissue reconstruction of the large defects of the dorsal and plantar aspects of the foot upto base of the toes. Reverse peroneal artery flap needs meticulous dissection of the peroneal artery from the fibula.

Do the Histological Differences of Soft Tissue Sarcomas Affect the Rate of Skin Defect Reconstruction?

In soft tissue sarcoma (STS) resection, flap reconstruction and/or skin grafting is frequently required. However, it is not clear whether the histological difference affects the rate of reconstruction. The present study aimed to investigate it. This study compared in 5 classifications (105 adipocytic tumors, 102 fibroblastic tumors, 39 muscle tumors, 31 peripheral nerve sheath tumors, and 178 tumors of uncertain differentiation). In addition, the reconstruction rates of detailed tumor sites were compared. The median and case number (percentage) were calculated. Tumor size (adipocytic 112 mm vs fibroblastic 79 mm, muscle 72 mm, nerve 90 mm, uncertain 74 mm, P < 0.0001 in all comparisons), histological low-grade rates (adipocytic 43.8% vs uncertain 3.9%, P < 0.0001; fibroblastic 46.1% vs muscle 15.4%, P = 0.003; fibroblastic vs uncertain, P < 0.0001; nerve 19.4% vs uncertain, P = 0.003) and reconstruction rates (adipocytic 5.7% vs fibroblastic 42.2%, muscle 33.3%, nerve 32.3%, uncertain 25.8%, P < 0.0001 in all comparisons) were significantly different. In the region of lower extremity, the regions of thigh [adipocytic 1/62 (1.6%) vs fibroblastic 7/32 (21.9%), P = 0.002], and lower leg [adipocytic 1/16 (6.3%) vs fibroblastic 11/19 (57.9%), P = 0.002] were significantly different. In adipocytic tumors, the tumor size was significantly large; however, the skin defect reconstruction rate was significantly lower than that of the other STS. Histologically, the reconstruction rate of STS derived from superficial tissue increases, whereas the reconstruction rate derived from deep tissue such as adipocytic tumor decreases.

First dorsal metacarpal artery flap in soft tissue reconstruction of recurrent thumb squamous cell carcinoma

Background. Subungual squamous cell carcinoma (SCC) of thumb is a rare disease. However, it is the most common malignancy affecting the nail bed. Early recognition is crucial and important for prompt diagnosis and effective treatment. Often this tumour needs to be treated surgically with wide local resection, which results in a defect in the thumb. If not handled appropriately, such defects render restriction in functionality of the involved thumb as well as a poor aesthetic outcome. In the worst-case scenario, it may result in a poor function of involved hand. Thus, reconstruction of the involved thumb is necessary. The main aim of reconstruction is to regain the hands' function and preserved the thumbs' sensation. Secondarily, to have an aesthetically pleasing hand. Our hands carry out delegate job and important duty for daily function. Especially, the thumb working together with the other fingers to carry out the hand function as one unit. Loss of thumb function affects the whole performance of the hand. Case descriptions. We report a case of recurrent subungual squamous cell carcinoma of thumb, which had wide local resection and subsequently underwent soft tissue coverage with an islanded first dorsal metacarpal artery (FDMA) perforator flap. One month after surgery, the patient was able to regain a good functional outcome of the hand. In this report, we discussed the procedures that had been done. Conclusion. The patient regained full functional hand after reconstruction with preserved sensation over distal thumb. The aesthetic outcome is satisfactory. The FDMA perforator flap is a very pliable and robust flap for reconstruction of distal thumb defect.

Novel V-shaped kiss flap harvest technique for the forearm free flap in soft tissue reconstruction

IntroductionRadial forearm flap (RFF) is widely used in oral reconstruction. However, the donor-site defect remains the main limit. In this paper, V-shaped kiss RFF (VRFF) is described as a novel technique to improve aesthetics and function of it. A retrospective study was conducted to introduce VRFF and evaluate its effect and safety.MethodsA total of 21 patients who underwent VRFF for oral reconstruction, and 23 patients who underwent conventional RFF from February 2016 to April 2018 were included in this study. Direct comparisons were made on patient’s subjective evaluation of postoperative hand function and degree of scarring and objective donor-site function assessment including range of wrist movements and grip strength before and after surgery between the two groups.ResultsNo skin grafts were used in the VRFF group, and 20 of 21 patients achieved primary healing at donor site, while all patients from the RFF group had skin grafts. And 18 of 23 patients achieved primary healing. The postoperative scar score of donor site in the VRFF group was significantly higher than that in the RFF group (3.4 vs 2.8, P = 0.035). There were no significant differences in other subjective evaluation and donor-site morbidity and hand function assessment.ConclusionVRFF is able to provide a new and simple method to close donor-site defect and realize a better healing in donor site.

The reliability of submental flap for soft tissue reconstruction in patients with carcinoma of the oral cavity

BackgroundThe submental island flap (SIF) is a reliable option for reconstruction of the defects of the oral cavity following cancer resection. Advantages include reliable axial vascular pedicle, low donor site morbidity, good functional and cosmetic outcome, shorter operative time and lower cost compared to free flap reconstruction. Materials and methodsA total of 32 consecutive patients with carcinoma of the oral cavity were included in this study. All patients underwent resection and immediate reconstruction with SIF pedicled the submental vessels. Donor and recipient site morbidity, functional outcome, and locoregional recurrences are reported. ResultsThe study included 22 males (69%) and 10 females. The mean age was 54 years (range of 31–79 years). The most common primary tumor site was the tongue (15 patients, 47%), followed by the buccal mucosa, alveolar margin, floor of mouth, lower lip and hard palate. In 25 patients (78%) the flap survived completely. Complete flap loss occurred in one patient (3%). Six patients (19%) developed complications related to flap vascularity. 21 patients (66%) resumed normal diet, while 11 patients (34%) tolerated only soft diet. Over a median follow up was of 15 months (range of 3–62 months), 21 patients (66%) are alive and disease free, while 8 patients died, of whom 4 of locoreginal recurrences. ConclusionsSIF is reliable for reconstruction of the intraoral soft tissue defects following cancer resection. The functional and cosmetic outcomes are satisfactory and donor site morbidity is low. Careful patient selection is necessary for favorable outcome.

Robot-assisted radial forearm free flap harvesting: a propensity score-matched case-control study.

Although some surgeons prefer anterolateral thigh and latissimus dorsi flap for soft tissue reconstruction in the head and neck area because it minimizes donor site complications, the radial forearm flap remains the workhorse for soft tissue reconstruction due to its reliability. To reduce donor site morbidity, the authors developed a novel technique for radial forearm flap harvesting using a robotic device. 42 radial forearm free flap reconstruction cases were studied, consisting of 31 conventional and 11 robot-assisted cases. 1:1 propensity score matching was done according to age, sex, previous and postoperative radiation therapy history and method used for vein anastomosis. There was no significant difference in flap outcome, which was 100% vitality in the robot-assisted group and 90.9% vitality in the conventional group. The robot-assisted group showed significantly longer mean harvesting time than did the conventional group, being 107.2min and 67.0min, respectively. Robot-assisted radial forearm flap harvesting can reduce donor site complications by minimizing incision. When more surgical experience is gained under appropriate case selection, we expect our robot-assisted method will yield a harvesting time similar to that of the conventional method and thus become more reliable and feasible.

Autologous menisci-cruciate ligament composite as a flap for soft tissue reconstruction following malignant bone tumor resection around the knee.

Despite significant improvements in oncological treatment, the management of soft tissue defects following malignant tumor resection remains challenging. We investigated whether autologous menisci and cruciate ligament, which are traditionally discarded, can be recycled as a supplemental flap in repairing soft tissue defects following malignant bone tumor resection and endoprosthetic reconstruction around the knee. Four knee specimens were dissected to provide a basis for the design of the menisci-cruciate ligament composite. Then, 40 patients with bone malignancies around the knee were enrolled and underwent reconstruction with free or vascularized composite following malignant tumor resection. The clinical, radiographic, and functional outcomes of this technique were evaluated in >1-year follow-up in each patient and compared with 87 patients who suffered from bone malignancies around the knee and were treated by limb salvage but without composite at our center over the same period. During the follow-up, a composite from one patient who underwent secondary amputation was retrieved and examined for in vivo remodeling. Fourteen patients were treated with vascularized composite transfer (10 distal femurs and 4 proximal tibias) and 26 patients with free composite transfer (19 distal femurs and 7 proximal tibias). The composite can be used to cover the area of soft tissue defect from 22 to 48.38 cm2 (34.67 ± 6.48 cm2 ). With contrast-enhanced ultrasound, peripheral rim healing and dotted blood flow signal at the side of anastomosis were detected on a patient 16 months after free composite transfer. Gross macroscopic remodeling and histopathologic analysis of a retrieved composite also indicated good healing with surrounding tissues and living cells in the composite. The complications and oncologic outcomes were comparable between study and control cohorts, but better Musculoskeletal Tumor Society (MSTS) score for patients reconstructed with composite (26.68 vs. 25.66, p =0.004). Of note, MSTS score was higher for patients reconstructed with composite at distal femur subdivision compared with the same subdivision in the control cohort (26.97 vs. 25.90, p =0.009). No statically significant difference was noted in complications, oncologic, and functional outcomes for patients reconstructed with free or vascularized composite. Autogenous menisci-cruciate ligament composite is an alternative option for soft tissue reconstruction. Either vascularized or free composite can be applied, depending on the size and localization of the defect.

Versatility of Radial Forearm Free Flap in Reconstruction of different Defects: A Cross-sectional Study

Introduction: The Radial Forearm Free Flap (RFFF) is a commonly used flap for soft tissue reconstruction, offering several advantages despite sacrificing the radial artery in the forearm. Understanding the anatomy of radial artery perforators, including their distribution, territory, and flow is crucial for reliable and safe flap harvest and design. Aim: To describe the versatility and applications of RFFF in reconstructing defects in various body parts. Materials and Methods: This cross-sectional study was conducted in the Department of Plastic and Reconstructive Surgery at SCB Medical College and Hospital, Cuttack, between January 2019 and January 2021, on 39 cases (age group: 20-70 years) who underwent RFFF. RFFF was utilised for reconstruction of the lip, palate, buccal mucosa, tongue, foot, nose, and phallus. Preoperative evaluation included assessing the vascular status of the non dominant hand using the Allen’s test. Results: RFFF was used for postcancer resection reconstruction in 11 cases of buccal mucosa (28.2%), 7 cases of the lip (17.9%), 6 cases of the tongue (15.3%), 2 cases of the palate (5.1%), 2 cases of phallus reconstruction (5.1%), 1 case of post-traumatic nose defect, and 1 case of 1st web space of the hand (2.5%). In 26 cases of postcarcinoma resection reconstruction, RFFF was used for buccal mucosa, lip, tongue, and palate. The patients were followed up for 2-8 months. Conclusion: RFFF fulfills most of the anatomical prerequisites for an ideal flap, providing a microvascular reconstructive option for patients with large defects in the head and neck, foot and ankle, and phallus. It exhibits a high success rate, good aesthetic and functional outcomes, allowing for the reconstruction of various defects. This study confirms the reliability of the radial free flap as a method for reconstructive surgery.

Versatility of antero-lateral thigh free flap in reconstruction of defects in different parts of body - our experience

Extensive soft tissue defects pose a great deal of challenge to the reconstructive surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh (ALT) flaps for soft tissue reconstruction of defects following tumor excision, trauma and post burn. A retrospective review of 19 patients undergoing ALT Flaps for various reasons from Dec 2018 to Jan 2021 was performed to determine perioperative factors, demographic profile, complications and outcomes. The mean age of the study population was 47.2 years. The male to female ratio was 2.16:1 (68.5 % male, 31.5% females). The etiology of soft tissue defect was post-tumor resection-47.36%, truam-36.8%, post burn reconstruction-10.5%. The defect sites were most commonly leg-31.5%, upper extremity-26.3%, buccal mucosa-15.7%, scalp-10.5%, tongue-10.5%, breast-5.2%. Flaps were harvested from right thigh in 52% of cases and left thigh in 58% of the cases. Donor site was closed primarily in 11 cases (57.8%), SSG coverage was done for 8 cases (42.8%). The minimum hospital stay post op was 12 days, maximum being 45 days. Postoperative complications were seen in 36.8% of the cases. Partial flap necrosis occurred in 3 cases (15.7%), complete necrosis in 1 case (5.2%), donor site morbidity was seen in 3 cases (15.7%). In the post-operative period hematoma and infection occurred in 3 cases. ALT Flap in experienced hands provide reliable coverage of large soft tissue defects with excellent aesthetic and functional outcomes with minimal donor site morbidity.

Robotic-assisted Surgery and its Impact on Patient Outcomes: A Narrative Review

Introduction: The Radial Forearm Free Flap (RFFF) is a commonly used flap for soft tissue reconstruction, offering several advantages despite sacrificing the radial artery in the forearm. Understanding the anatomy of radial artery perforators, including their distribution, territory, and flow is crucial for reliable and safe flap harvest and design. Aim: To describe the versatility and applications of RFFF in reconstructing defects in various body parts. Materials and Methods: This cross-sectional study was conducted in the Department of Plastic and Reconstructive Surgery at SCB Medical College and Hospital, Cuttack, between January 2019 and January 2021, on 39 cases (age group: 20-70 years) who underwent RFFF. RFFF was utilised for reconstruction of the lip, palate, buccal mucosa, tongue, foot, nose, and phallus. Preoperative evaluation included assessing the vascular status of the non dominant hand using the Allen’s test. Results: RFFF was used for postcancer resection reconstruction in 11 cases of buccal mucosa (28.2%), 7 cases of the lip (17.9%), 6 cases of the tongue (15.3%), 2 cases of the palate (5.1%), 2 cases of phallus reconstruction (5.1%), 1 case of post-traumatic nose defect, and 1 case of 1st web space of the hand (2.5%). In 26 cases of postcarcinoma resection reconstruction, RFFF was used for buccal mucosa, lip, tongue, and palate. The patients were followed up for 2-8 months. Conclusion: RFFF fulfills most of the anatomical prerequisites for an ideal flap, providing a microvascular reconstructive option for patients with large defects in the head and neck, foot and ankle, and phallus. It exhibits a high success rate, good aesthetic and functional outcomes, allowing for the reconstruction of various defects. This study confirms the reliability of the radial free flap as a method for reconstructive surgery.

Comparison of lateral arm flap and posterior interosseous artery flap for soft tissue reconstruction of the elbow.

The study aimed to evaluate and compare the two different flap techniques used for the reconstruction of soft tissue defects in the elbow region: the lateral arm flap (LAA) and posterior interosseous artery (PIA) flap. The retrospective study included 12 patients who underwent surgical treatment for soft tissue defects between 2012-2018 at the clinic. The study evaluated demographic data, flap size, operating time, donor site, flap complications, number of perfora-tors, and functional and cosmetic outcomes. Results showed that patients who underwent PIA flap had significantly smaller defect size than those who underwent LAA flap (p<0.001). However, there were no significant differences between the two groups (p>0.05). Patients who received PIA flaps had significantly lower QuickDASH scores, indicating better functional results (p<0.05). The operating time was significantly shorter in the PIA group than in the LAA flap group (p<0.05). Additionally, the range of motion (ROM) of the elbow joint was significantly higher among the patients who received the PIA flap (p<0.05). The study concludes that both flap techniques are easy to apply depending on the surgeon's experience, have low complication risk, and provide similar functional and cosmetic results in similar defect sizes.

Comparison of Reverse Sural Artery Fasciocutaneous Flap in Soft Tissue Reconstruction Between above Ankle and Below Ankle Defect

Background Fasciocutaneous reverse sural artery flap is a popular option to treat soft tissue defects in the distal leg, ankle, and foot region.&#x0D; Objective To compare the results of sural artery flap reconstruction between the above ankle and below ankle soft tissue defect.&#x0D; Method It was a retrospective study of sural flap reconstruction of varied etiology for the defect grouped as above ankle and below ankle operated over a period of five years. Flap and graft take-up, rate of primary healing, margin necrosis, and complications were the assessed outcome variables.&#x0D; Result There were a total of 37 patients, 17 cases of the above ankle and 20 cases of below ankle sural flap reconstruction analyzed in the study. Road traffic accident was the most common cause and the mean size of the defect was 40.70 cm2. The overall flap take-up rate was 94.6%, partial margin necrosis was in 6 patients, and &gt; 50% flap necrosis was in 2 cases. The rate of primary healing, margin necrosis and mean healing time were 17 (100%) vs 12 (60%), 0 vs 8 cases (6 margin necrosis and 2 cases of &gt; 50% of flap necrosis), and 20.04 days vs 22.50 days respectively in the above ankle and below ankle flap reconstruction groups. These differences were statistically significant.&#x0D; Conclusion Fasciocutaneous reverse sural artery flap is an excellent choice for reconstruction of the defect at the distal leg and around the ankle region with a high success rate. Below ankle flap reconstruction showed a higher rate of margin necrosis, longer healing time, and less rate of primary healing as compared to the above ankle group.

A novel computed tomography angiography technique: guided preoperative localization and design of anterolateral thigh perforator flap

BackgroundAnterolateral thigh perforator (ALTP) flap is considered a versatile flap for soft tissue reconstruction. Computed tomography angiography (CTA) is used for mapping perforator in abdominal-based reconstruction; however, it is less commonly used in ALTP due to its poor imaging efficacy. In this study, we introduced a novel CTA technique for preoperative localization and design of ALTP flap and evaluated its value in directing surgical reconstruction.ResultsThirty-five patients with soft tissue defects were consecutively enrolled. Modified CTA procedures, such as sharp convolution kernel, ADMIRE iterative reconstruction, 80 kV tube voltage, high flow contrast agent and cinematic rendering image reconstruction, were used to map ALTPs. A total of 287 perforators (including 884 sub-branches) were determined, with a mean of 5 perforators per thigh (range 2–11). The ALTPs were mainly concentrated in the “hot zone” (42%, 121/287) or the distal zone (41%, 118/287). Most perforators originated from the descending branch of the lateral circumflex femoral artery (76%, 219/287). Three perforator types, namely musculocutaneous (62%, 177/287), septocutaneous (33%, 96/287), and mixed pattern (5%, 14/287), were identified. The median pedicle length measured by two methods was 4.1 cm (range 0.7–20.3 cm) and 17.0 cm (range 4.7–33.9 cm), respectively, and the median diameter of the skin flap nourished by one perforator was 3.4 cm (IQR 2.1–5.7 cm). Twenty-eight ALTP flaps were obtained with the guidance of CTA, and 26 flaps survived after follow-up.ConclusionsThe proposed CTA mapping technique is a useful tool for preoperative localization and design of ALTP flap.

Application of the distally based sural neurocutaneous flaps in the management of foot and ankle defects in patients with diabetic foot.

BackgroundWe report our experience on the use of a distally based sural flap for soft tissue reconstruction of foot and ankle defects in patients with diabetic foot.MethodsThe actual study is a retrospective, open, non-controlled, and clinical study of 25 patients treated with diabetic foot on whom reconstruction with distally based sural neurocutaneous flaps was performed from May 2019 to December 2021.ResultsThe mean age was 64.9 years, and there were 15 male and 10 female patients. The mean follow-up was 9.8 months, which ranged from 6 to 12 months. The size of the flaps ranged from 6 × 5 to 15 × 9 cm2. Twenty-two of the 25 flaps survived intact with sufficient blood supply. Two cases had a small superficial necrosis, which was resolved after a change of daily dressing and was heeled eventually. In one case, partial necrosis was observed that was managed with minor revision and the use of split-thickness skin graft.ConclusionsThe distally based sural flap is considered to be useful for reconstruction of foot and ankle defects in patients with diabetic foot.

Versatility of antero-lateral thigh free flap in reconstruction of defects in different parts of our body- our experience

Introduction Extensive soft tissue defects pose a great deal of challenge to the reconstructive surgeon.The aim of this study is to analyse the outcome of free anterolateral thigh(ALT) flaps for soft tissue reconstruction of defects following tumor excision,trauma and post burn. Methods : A retrospective review of 19 patients undergoing ALT Flaps for various reasons from Dec 2018 to Jan 2021 was performed to determine perioperative factors, demographic profile , complications and outcomes. Results : The mean age the study population was 47.2 years. The male to female ratio was 2.16:1 (68.5 % male, 31.5% females). The etiology of soft tissue defect was post- tumor resection – 47.36%, truam-36.8%, post burn reconstruction- 10.5% . The defect sites were most commonly leg-31.5%, upper extremity- 26.3%, buccal mucosa- 15.7%, scalp-10.5%, tongue- 10.5%,breast- 5.2%.Flaps were harvested from right thigh in 52% of cases and left thigh in 58% of the cases. Donor site was closed primarily in 11 cases (57.8%), SSG coverage was done for 8 cases ( 42.8%). The minimum operating time was 205 minutes and maximum was 435 minutes, with an average time of …………..The minimum hospital stay post op was 12 days , maximum being 45 days.