Outcomes of Lower Extremity Defects Reconstruction with Free Flaps

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The aims of soft-tissue reconstruction of lower leg defects are covering and repairing wounds, maintaining limb function, preventing amputation, and improving quality of life.Methods: In this cross-sectional study, 27 patients underwent soft-tissue reconstruction of lower extremities with free flaps were enrolled. The cause and the site of defects, free flap types, anastomosis types, survival rate, and complications were assessed.Findings: 27 patients with mean age of 31 years with large lower extremity defects with at least 2 months follow up were assessed. The sites of defects were middle and distal one-third of the legs (21 cases), foot and heel (4 cases), and knees (2 cases), and causes of defects were trauma (21 cases), and chronic wounds (2 cases). Used musculocutaneous free flaps were for latissimus dorsi (15 cases), rctus abdominis (8 cases), and gracilis (4 cases). 43 and 11 cases had end-to-end and end-to-site anastomosis, respectively. Survival rate was 88.9 percent and 3 flaps were failed due to thrombosis.Conclusion: Using free flaps with appropriate vascular pedicles is a reliable and effective method for reconstruction of lower leg large defects.

Keywords

References

  1. Kang MJ, Chung CH, Chang YJ, Kim KH. Reconstruction of the lower extremity using free flaps. Arch Plast Surg 2013; 40(5): 575-83.
  2. Heller L, Kronowitz SJ. Lower extremity reconstruction. J Surg Oncol 2006; 94(6): 479-89.
  3. Suda AJ, Thoele P, Heppert VG. Flaps for soft tissue defect closure in the distal lower leg. Unfallchirurg 2014; 117(1): 61-9. [In German].
  4. Bajantri B, Bharathi RR, Sabapathy SR. Wound coverage considerations for defects of the lower third of the leg. Indian J Plast Surg 2012; 45(2): 283-90.
  5. Hill JB, Vogel JE, Sexton KW, Guillamondegui OD, Corral GA, Shack RB. Re-evaluating the paradigm of early free flap coverage in lower extremity trauma. Microsurgery 2013; 33(1): 9-13.
  6. Feldman DL, Levin LS. Extended techniques for limb salvage using free flaps. In: Ascher E, Hollier LH, Strandness DE, Towne JB, Calligaro K, Kent KC, editors. Haimovici's vascular surgery. 5th ed. Hoboken, NJ: Wiley; 2008. p. 587-91.
  7. Franken JM, Hupkens P, Spauwen PH. The treatment of soft-tissue defects of the lower leg after a traumatic open tibial fracture. Eur J Plast Surg 2010; 33(3): 129-33.
  8. Gonzalez MH, Tarandy DI, Troy D, Phillips D, Weinzweig N. Free tissue coverage of chronic traumatic wounds of the lower leg. Plast Reconstr Surg 2002; 109(2): 592-600.
  9. Xu XY, Zhu Y, Liu JH. Reconstruction of soft tissue defects of the lower limb using the free serratus anterior flap. Orthop Surg 2009; 1(2): 113-20.
  10. Baumann DP, Chang DW. Free Flap Reconstruction for complex lower extremity wounds. Tech Orthop 2009; 24(2): 130-8.
  11. Kim JT, Kim SW. Concept of perforator flap and reconstruction using microsurgery. J Korean Med Assoc 2014; 57(8): 695-703. [In Korean].
  12. Biswas D, Kalam A, Ahmed T, Khan RK. Results of microvascular free flap for reconstruction of soft tissue defects: Our early experience. Bangladesh Journal of Plastic Surgery 2012; 3(2): 33-7.
  13. Basheer MH, Wilson SM, Lewis H, Herbert K. Microvascular free tissue transfer in reconstruction of the lower limb. J Plast Reconstr Aesthet Surg 2008; 61(5): 525-8.
  14. Pinsolle V, Reau AF, Pelissier P, Martin D, Baudet J. Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases. J Plast Reconstr Aesthet Surg 2006; 59(9): 912-7.
  15. Wettstein R, Schurch R, Banic A, Erni D, Harder Y. Review of 197 consecutive free flap reconstructions in the lower extremity. J Plast Reconstr Aesthet Surg 2008; 61(7): 772-6.
  16. Fischer JP, Wink JD, Nelson JA, Cleveland E, Grover R, Wu LC, et al. A retrospective review of outcomes and flap selection in free tissue transfers for complex lower extremity reconstruction. J Reconstr Microsurg 2013; 29(6): 407-16.
Journal of Isfahan Medical School
Volume 35, Issue 439 - Serial Number 439
May and June 2017
Pages 883-889

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History

  • Receive Date: 07 June 2017
  • Revise Date: 01 November 2024
  • Accept Date: 06 April 2022

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