Bypass Flap Reconstruction, A Novel Technique for Distal Revascularization: Outcome of First 10 Clinical Cases

Malikov, Sergueï; Magnan, Pierre-Édouard; Casanova, Dominique; Lepäntalo, Mauri; Valerio, Nicolas; Ayari, R.; Champsaur, Pierre; Branchereau, A

doi:10.1016/j.avsg.2009.09.002

Cited by 15 publications

(4 citation statements)

References 20 publications

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“…In addition, the flap hooked on the bypass increases the flow through by reducing distal resistance [12,26,27,28,29]. Long- time results have demonstrated a rate of over 50% of Limb salvage after combined bypass- surgery and free flap reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

2013

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IntroductionDiabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot.There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity.Patients and Methods41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used.ResultsThere were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated.DiscussionLarge defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure.Amputation means reduction of quality of life and can lead to an increased mortality postoperatively.

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Section: Discussionmentioning

confidence: 99%

Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

2013

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“…26 Many articles have been published that showed the utility of this approach, particularly in the lower extremity in the face of poor outflow. 27,28 The addition of a free flap to the bypass certainly improves outflow for the flap and may well provide some element of revascularization of the extremity via angiogenesis from the flap to the limb. 29 Omentum has long been appreciated to produce angiogenic factors that can be beneficial to healing.…”

Section: Vascularized Omental Transfermentioning

confidence: 99%

Revascularization Options for Terminal Distal Ischemia

Pederson

2015

Hand Clinics

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“…In these cases, bypass flap surgery offers an opportunity to avoid amputation (2,3). The unique shock absorbing design of the heel region poses a distinct reconstructive challenge (4,5).…”

mentioning

confidence: 99%

An improvised arterial end‐to‐side anastomosis from flap to arterialised vein graft in the diabetic foot

Jandali

Nizar

Loh

et al. 2014

International Wound Journal

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Bypass Flap Reconstruction, A Novel Technique for Distal Revascularization: Outcome of First 10 Clinical Cases

Cited by 15 publications

References 20 publications

Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

Vascular Surgery, Microsurgery and Supramicrosurgery for Treatment of Chronic Diabetic Foot Ulcers to Prevent Amputations

Revascularization Options for Terminal Distal Ischemia

An improvised arterial end‐to‐side anastomosis from flap to arterialised vein graft in the diabetic foot

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