A new distally based fasciocutaneous flap of the leg

Amarante, José; Costa, H.; Reis, Jorge; Soares, Ribeirinho

doi:10.1016/0007-1226(86)90043-3

Cited by 157 publications

(59 citation statements)

References 3 publications

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“…3 Many authors have recommended distally-based fasciocutaneous flaps to obtain cover of distal defects in the lower limb. [18][19][20][21][22][23][24][25] In an effort to reduce complications, we have used the principle of a distally-based fasciocutaneous flap for the surgical approach to tendo Achillis. An incision adjacent to the tendon is avoided and wide exposure is achieved.…”

Section: Discussionmentioning

confidence: 99%

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

Chana

Chen

Jain

2002

The Journal of Bone and Joint Surgery. British volume

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he consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avoids making an incision directly over the tendon, provides good exposure, and maintains the vascularity of the skin overlying the tendon. The current, preferred surgical approach to tendo Achillis is a longitudinal incision, either on its medial or lateral side. 1,2 There is, however, a risk of breakdown of the wound because of poor vascularity of the skin in this region. As it heals the tendon lies directly beneath the incision. The potential complication is skin loss with exposure and necrosis of the tendon. We describe an approach to tendo Achillis which uses the principle of a distally-based fasciocutaneous flap in order to avoid making an incision too close to the tendon. Patients and MethodsOperative technique. A distally-based fasciocutaneous flap is raised with the vertical limbs just posterior to each malleolus. The transverse limb is made above the tendinous portion of gastrocnemius (Fig. 1). Since this is a randompattern fasciocutaneous flap, the ratio of the length to width is kept to a maximum of 3:1.3 The flap is raised in the subfascial plane in order to achieve exposure of the tendon (Fig. 2). On the lateral side, care must be taken to ensure T that the sural nerve is not damaged. Closure of the skin is achieved using 4-0 vicryl subcuticular dermal sutures with the knots buried and 4-0 nylon for the skin. In tendonlengthening procedures with a chronic plantar flexion deformity, deficiency of skin may require either a full-thickness graft from the groin, or a split-thickness graft from the thigh (Fig. 3). Illustrative case reportsCase 1. A 51-year-old man presented with a rupture of the right tendo Achillis sustained while playing basketball one week earlier. He underwent surgery using a distally-based fasciocutaneous flap and the tendon was repaired with 2/0 prolene. He had an uneventful postoperative recovery. At the follow-up at six months he was fully mobile, although he had a slightly hypertrophic scar at the medial malleolus. Case 2. A 45-year-old man presented with a rupture of his left tendo Achillis which he had sustained one month earlier.He underwent surgery using a distally-based fasciocutaneous flap and the tendon was repaired with 2/0 prolene. His postoperative recovery was uneventful. Seven months after surgery the scar had healed and he was walking normally. Case 3. A 25-year-old man had suffered a crush injury to his right foot and ankle ten years earlier which had remained untreated. He presented with a plantar flexion deformity of his right foot and was only able to walk on tiptoe. Examination revealed a shortened and contracted tendo Achillis. Radiographs revealed no bony abnormality. He underwent surgery to lengthen the tendon. An inci...

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Section: Discussionmentioning

confidence: 99%

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

Chana

Chen

Jain

2002

The Journal of Bone and Joint Surgery. British volume

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“…The flap was supplied by a septocutaneous vessel issued from the peroneal artery that located in the postero-lateral septum of the lower leg and about 10cm above the lateral malleolus. In 1986 Amarante et al [7] reported a similar medial sural flap supplied by a perforator from the posterior tibial artery that located in the posteromedial septum of the lower leg. In 1988 Masquelet et al [8] introduced the lateral supramalleolar flap that perfused by the anterior perforator of the peroneal artery located at 5 cm above the lateral malleolus.…”

Section: Historic Perspectivementioning

confidence: 99%

Distally based perforator sural flaps for foot and ankle reconstruction

Chang

2015

WJO

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Distally based perforator sural flaps from the posterolateral or posteromedial lower leg aspect are initially a neurofasciocutaneous flap that can be transferred reversely to the foot and ankle region with no need to harvest and sacrifice the deep major artery. These flaps are supplied by a perforating artery issued from the deep peroneal artery or the posterior tibial artery, and the chainlinked adipofascial neurovascular axis around the sural/ saphenous nerve. It is a versatile and reliable technique for soft-tissue reconstruction of the heel and ankle region with 180-degrees rotation. In this paper, we present its developing history, vascular basis, surgical techniques including flap design and elevation, flap variations in pedicle and component, surgical indications, and illustrative case reports with different perforating vessels as pivot points for foot and ankle coverage.

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“…Porém, tem havido certa preocupação em oferecer resultados mais estéticos em cirurgias reparadoras e até retalhos microcirúrgicos com características mais próximas da região receptora 20 . Os retalhos fasciocutâneos ampliaram as possibilidades de cobertura cutânea adequada de lesões de pequenas e médias extensões em regiões onde é mais difícil, como nas regiões distais da perna, tornozelo e pé 21 . Os retalhos menos espessos oferecem características ideais (like to like): cor, espessura e textura semelhantes; ter pedículo constante preditível e reprodutível, aceitável morbidade de área doadora; evita sacrifício de artéria e músculos e, além de oferecer tempos cirúrgicos com tempos menores, menos complexos (incluindo o tipo de anestesia) 7,13 , com riscos semelhantes aos de outros retalhos.…”

Section: Conclusãounclassified

Retalho supramaleolar de fluxo reverso: aplicações clínicas

Batista

2011

Rev. Bras. Cir. Plást. (Impr.)

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RESUMOAs regiões distais do membro inferior, incluindo o terço inferior da perna e os pés, são áreas muito propensas a perda de partes moles por trauma e lesões tróficas. A posição anterior da tíbia, com sua cobertura pouco espessa e vulnerável, além da grande quantidade de tendões, que não podem permanecer expostos, exigem uma cobertura cutânea rápida e, ao mesmo tempo, complexa. A situação em relação à direção do fluxo sanguíneo, a escassez de ventres musculares para retalhos e pele pouco elástica para retalhos randomizados viá-veis complicam esta situação. No passado, retalhos com transferência intermediária foram utilizados; assim como os de perna cruzada, "cross leg", ainda são, com desvantagens importantes: dependem de mais de um tempo cirúrgico, geram muito desconforto ao paciente e nem sempre são eficazes. A microcirurgia tornou-se uma opção que contribui muito para cobertura de lesões neste aspecto, porém, depende de equipe com treinamento e material especializado. As áreas doadoras são maiores, podem causar relativo déficit funcional e utilizam troncos vasculares maiores. Os retalhos fasciocutâneos de fluxo reverso podem contribuir para a cobertura de lesões pequenas e médias nesta localização, com sequelas funcionais e estéticas menores; e menor tempo cirúrgico. Constitui eficiente opção cirúrgica por sua facilidade, segurança e versatilidade. Neste estudo, temos o objetivo demonstrar o retalho supramaleolar de fluxo reverso utilizado em 4 casos, com aplicações em situações diferentes, com resultados satisfatórios de fácil execução e reprodução.Descritores: Retalhos cirúrgicos. Traumatismos da perna. Traumatismos do tornozelo. Extremidade inferior/cirurgia. ABSTRACTThe regions of the distal lower limb, including the 1/3 lower leg and foot areas are very prone to loss of soft tissue for trauma and ulcerations. The anterior position of the tibia, with its coverage slightly thick and vulnerable, besides the large amount of tendons, which can not remain exposed, requiring skin coverage quickly and simultaneously complex. The situation with respect to the direction of blood flow, lack of muscle bellies for flaps and skin flaps for inelastic randomized viable complicates this situation. In the past, with intermediate transfer flaps were used, as the leg cross, are still with major drawbacks: they rely on more than one occasion, generate a lot of discomfort to the patient and are not always effective. Microsurgery has become an option that helps a lot to cover injuries this point, however, depends on the team with training and specialized equipment. Donor areas are larger, can cause functional impairment and use on major vascular trunks. The fasciocutaneous flaps of reverse flow can contribute to the coverage of small and medium lesions in this location, with minor aesthetic damage and functional and less time for surgery. It constitutes effective surgical option for its ease, safety and versatility. In this study we demonstrate supramalleolous flap of reverse flow used in 4 cases, with applications in diffe...

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A new distally based fasciocutaneous flap of the leg

Cited by 157 publications

References 3 publications

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

Distally based perforator sural flaps for foot and ankle reconstruction

Retalho supramaleolar de fluxo reverso: aplicações clínicas

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