Background
Back reconstructions using a flap are relatively rare, and clinical reports on such reconstructions are few. We analyzed whether a pedicled flap or free flap was best for treating back defects and established a simplified algorithm for flap selection.
Methods
We retrospectively analyzed the cases of 22 patients who underwent flap reconstructions for the back between July 2000 and August 2016. We extracted data on the operative time, defect size, patients' height and body weight, and reoperation, and each defect size was calculated as a percentage in relation to the body surface area (BSA). We compared these values between both flap types using univariate analysis. In addition, reconstructions using pedicled flaps were classified as single pedicled flap and combination pedicled flap reconstructions. The reasons for reoperation were also reviewed.
Result
Seventeen patients underwent reconstructions using pedicled flaps, and 5 patients underwent reconstructions using free flaps. The operative time and the percentage of defect size in relation to the BSA were significantly lower when using pedicled flaps than when using free flaps (P = 0.002, P = 0.046, respectively). There was no significant difference in terms of the rate of reoperation (P = 0.16) between the 2 types of reconstructions. The operative time was also significantly shorter when using combination pedicled flaps than when using free flaps. However, there was no significant difference in terms of the percentage of defect size in relation to the BSA between combination pedicled flaps and free flaps. Reoperation was necessary because of flap necrosis in pedicled flaps and skin graft necrosis in free flaps.
Conclusions
Our results demonstrated that pedicled flaps should be the first choice for back reconstruction, independent of the defect size, reoperation rate, and reason for reoperation. This is because the operation time required is significantly lower, which benefits patients and surgeons. Free flaps can be used when pedicled flaps cannot be used efficiently.
Highlights
To the best of our knowledge, this is the first report on lymphaticovenular anastomosis (LVA) for the Klippel-Trenaunay-Weber syndrome.
We performed seven LVA procedures for the right lower limb with the intention of preventing recurrent bouts of cellulitis.
The patient has been cellulitis-free for 1 year post-operatively, having previously had such infection every other month.
We suggest that LVA may be effective for the management of similar cases.
Adults with Down syndrome are more prone to develop intellectual, physical, and psychological disorders than their pediatric counterparts. It is pertinent to prevent the occurrence of severe complications in these patients. This case demonstrates the importance of support, regular follow‐up, and wound management in self‐care of adults with Down syndrome.
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