A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

Assi, Chahine; Samaha, Camille; Moussa, Moussa Chamoun; Hayek, T. El; Yammine, Kaissar

doi:10.1177/1938640018816378

Cited by 14 publications

(23 citation statements)

References 19 publications

(38 reference statements)

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“…7, Each included study had a majority of patients with one or more comorbidity, including diabetes mellitus, end-stage renal disease, hypertension, chronic osteomyelitis, or PVD. Seventeen studies only included patients with diabetes, 4,7,14,29,35,36,39,40,43,49,[53][54][55][56]59,60,65 five only included patients with PVD, 31,34,35,52,56 and three only included patients with chronic osteomyelitis. 43,44,47 ►Table 1 describes the number of studies that included patients with each comorbidity, the most prevalent being diabetes mellitus.…”

Section: Resultsmentioning

confidence: 99%

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

Kim

Tirrell

Dekker

et al. 2021

J Reconstr Microsurg

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Introduction Research in lower extremity (LE) wound management involving flap reconstruction has primarily focused on surgeon-driven metrics. There has been a paucity in research that evaluates patient-centered outcomes (PCO). This systematic review and meta-analysis examines articles published between 2012 and 2020 to assess whether reporting of functional and quality of life (QOL) outcomes have increased in frequency and cohesiveness, compared with the previous two decades. Methods PubMed and Ovid were queried with appropriate Medical Subject Heading (MeSH) terms for studies published between June 2012 and July 2020. For inclusion, each study had to report any outcome of any tissue transfer procedure to the LE in comorbid patients, including complication rates, ambulation rates, flap success rates, and/or QOL measures. The PCO reporting prevalence was compared with a previous systematic review by Economides et al which analyzed papers published between 1990 and June 2012, using a Pearson's Chi-squared test. Results The literature search yielded 40 articles for inclusion. The proportion of studies reporting PCO was greater for literature published between 1990 and 2012 compared with literature published between 2012 and 2020 (86.0 vs. 50.0%, p < 0.001). Functional outcomes were more commonly reported between 1990 and 2012 (78.0 vs. 47.5%, p = 0.003); similarly, ambulatory status was reported more often in the previous review (70.0 vs. 40.0%, p = 0.004). This study solely examined the rate at which PCO were reported in the literature; the individual importance and effect on medical outcomes of each PCO was not evaluated. Conclusion Less than 50% of the literature report functional outcomes in comorbid patients undergoing LE flap reconstruction. Surprisingly, PCO reporting has seen a downward trend in the past 8 years relative to the preceding two decades. Standardized inclusion of PCO in research regarding this patient population should be established, especially as health care and governmental priorities shift toward patient-centered care.

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Section: Resultsmentioning

confidence: 99%

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

Kim

Tirrell

Dekker

et al. 2021

J Reconstr Microsurg

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“…Some interesting systematical reviews showed that trauma is the most common indication for soft tissue reconstruction with the RSAF in the lower leg. 10 , 13 , 14 More than 60% of sural flaps were indicated because of trauma of the distal leg. Unfortunately, it is not frequently well documented nor differentiated in the literature whether the trauma caused open fracture, osteomyelitis, exposed osteosynthesis material, or only exposed soft tissue.…”

Section: Discussionmentioning

confidence: 99%

The reverse sural artery flap– How do modifications boost its reliability? A systematic analysis of the literature

Schmidt¹,

Jakubietz²,

Meffert³

et al. 2020

JPRAS Open

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The reverse sural artery flap (RSAF) was first described approximately four decades ago and has since been used frequently for reconstruction of soft tissue defects in the distal part of the leg. Although the popularity of this flap never reached the extent of that of free perforator flaps, it still serves as a reliable alternative. This has been demonstrated by the increased rate of publication on the technique in recent years. The number of authors reporting data has risen up to 20 reports a year. During this time, several new modifications of the flap were inaugurated in order to boost the efficiency and reliability of the flap. The goal of this systematic analysis of the literature was to gain information on the influences of the modifications of the RSAF with regard to consistency and complication rates. An overall survival rate of 95% and a rate of complications of 14% were reported in all the analyzed cases. Some modifications were able to improve flap viability but not at a statistically significant extent. Venous supercharging and the adipofascial variant of the RSAF provided the best results. The RSAF is still a remarkable flap design, especially as a backup solution or in circumstances without a microsurgical skilled surgeon. Further investigation with controlled randomized prospective trials is vital to confirm this finding with more evidence.

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“…Additionally, the free flap technique is not devoid of risks, mostly in a patient with diabetes. Assi et al 16 demonstrated that diabetes itself is not a risk factor for the outcome of a free flap, but we must consider that this procedure may entail the sacrifice of one leg’s artery in a patient with a considerable risk of developing a diabetic foot. 17 …”

Section: Discussionmentioning

confidence: 99%

Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand?

Baccarani

Maria

Pappalardo

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Necrobiosis Lipoidica (NL) is a rare necrotising disorder of the skin characterized by collagen degeneration, thickening of blood vessels, and granulomatous inflammatory process. Its main clinical features are brownish-red papules and yellowish plaques with atrophic central areas. NL affects 0.3% -1.2% of the diabetic population, mostly women (female/male ratio is 3:1). Management of NL is challenging, especially for large lesions refractory to medical therapy, thus requiring surgical excision as an alternative option. Due to the rare occurrence of this condition no treatment guidelines exist and individualized treatment mostly depends on the severity of the lesion, location and patient's expectations. A case of a 30-year-old diabetic woman with very high aesthetic expectations was succesfully treated with staged resections of a giant NL to the leg and reconstruction with dermal template and full thickness skin grafts. Grafts were taken from the groin region bilaterally and from the lower abdomen after a cosmetic mini-abdominoplasty procedure. This approach allowed for a stable and very satisfactory aesthetic result with no donor site exposed scars.

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A Comparative Study of the Reverse Sural Fascio-Cutaneous Flap Outcomes in the Management of Foot and Ankle Soft Tissue Defects in Diabetic and Trauma Patients

Cited by 14 publications

References 19 publications

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

The Need to Improve Patient-Centered Outcome Reporting Following Lower Extremity Flap Reconstruction: A Systematic Review and Meta-analysis

The reverse sural artery flap– How do modifications boost its reliability? A systematic analysis of the literature

Necrobiosis Lipoidica Affecting the Leg: What Is the Best Treatment in a Patient with Very High Aesthetic Demand?

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