Corrigendum to “Analysis of multiple risk factors affecting the result of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes mellitus” [J Plast Reconstr Aesthet Surg 67 (2014) 624–628]

Lee, Yung Ki; Park, Keun Yung; Koo, Youn Taek; Baek, Rong Min; Heo, Chan Yeong; Eun, Seok Chan; Lee, Tae Seung; Lee, Kyoung Min; Kim, Baek Kyu

doi:10.1016/j.bjps.2014.06.001

Cited by 2 publications

(4 citation statements)

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“…Only three studies limited to diabetic foot defects investigated possible risk factors for postoperative complications. 21 22 23 Oh et al 21 investigated 121 cases of microsurgical diabetic foot reconstruction and identified peripheral arterial disease, a history of angioplasties in the lower extremity and using immunosuppressive agents after kidney transplantation to increase the chance for flap loss, while ASA status showed no effect on flap survival. In contrast, Kim et al 22 found both impaired arterial status of the heel and ASA status to significantly increase the risk of flap failure in 37 patients with diabetic heel defects.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, Kim et al 22 found both impaired arterial status of the heel and ASA status to significantly increase the risk of flap failure in 37 patients with diabetic heel defects. Lee et al 23 analyzed 33 patients with free flap reconstruction for diabetic feet defects and found atherosclerotic calcifications and serum creatinine levels more than 1.28 mg dL (−1) to significantly affect the complication rate. In our study, none of the factors identified in the previously mentioned diabetic case series served as an independent risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…Other previous studies focusing on microsurgical extremity reconstruction could not find an association of hypertension with flap failure 22 26 31 or did not include arterial hypertension in their risk factor analysis. 23 32 33…”

Section: Discussionmentioning

confidence: 99%

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Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Mayr-Riedler

Wacker

Gedrich

et al. 2022

J Reconstr Microsurg

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Background: Defects at the forefoot frequently require microsurgical reconstruction, however reconstructive failure can lead to results inferior to primary amputation. The purpose of this study was to identify independent factors affecting surgical outcomes and hospitalization time in these patients. Methods: All patients that underwent free flap reconstruction of the forefoot between 2008 and 2019 were reviewed retrospectively. Statistical evaluation included binary logistic regression and correlation analysis. Results: A total of 93 free flap procedures were performed in 87 patients. The most common defect etiologies were acute trauma (30 cases; 32.3%), diabetic foot syndrome (20 cases; 21.5%) and infection (17 cases; 18.3%). Muscle flaps were used in 50 cases (53.8%) and fasciocutaneous flaps were used in 43 cases (46.2%). Major complications occurred in 24 cases (25.8%) including 11 total flap losses and 2 partial flap losses. Minor complications occurred in 38 cases (40.9%). Patients aged 60 years or above were at significant higher risk for major complications (p=0,029). Use of fasciocutaneous flaps (OR: 14.341; p=0.005), arterial hypertension (OR: 18.801; p=0.014) and operative time (min) (OR: 1.010; p=0.029) were identified as individual risk factors for major complications. Two venous anastomoses significantly reduced the risk for major complications (OR: 0.078; p=0.022). Multi resistant bacterial wound colonization (OR: 65.152; p<0.001) and defect size (OR: 1.007; p=0.045) were identified as independent risk factors for minor complications. The median hospital stay was 28 days (7-85 days). Age significantly correlated with the length of hospital stay (r=0.405, p<0.01). Conclusion: Our study identified independent risk factors that might help to make individual decisions whether to target microsurgical forefoot reconstruction or primary amputation. Two venous anastomoses should be performed whenever feasible, and muscle free flaps should be preferred in patients at higher risk for major surgical complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Mayr-Riedler

Wacker

Gedrich

et al. 2022

J Reconstr Microsurg

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“…Another consideration for free tissue transfers is atherosclerosis. 8 9 10 11 12 This is especially a concern in lower extremity reconstruction where distal segments of the lower limb have been noted to have severe stenosis in at-risk populations. 13 14…”

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confidence: 99%

Lower Extremity Reconstruction with Anterolateral Thigh Free-Flap Anastomoses: A Computational Fluid Dynamic Analysis

Jinka

Jinka²,

Janis

2023

J Reconstr Microsurg

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Background: The anterolateral thigh free flap is an option for repairing soft tissue defects of the distal lower extremity. This flap uses the descending branch of the lateral circumflex femoral (LCF) artery as the flap vessel. The recipient vessel in these flaps is often the anterior tibial (AT), posterior tibial (PT), or peroneal (P) arteries. Computational fluid dynamic (CFD) evaluation of anastomoses between these vessels can optimize outcomes. Methods: Thirty-eight CFD models were created to model ETS and ETE anastomoses for lower extremity reconstruction. 7/38 models represented ETS anastomoses between the LCF and AT arteries with varying anastomotic angles. 9/38 models represented 45-degree ETS anastomoses between varying diameters of the LCF and AT, PT, and P arteries. 9/38 models represented stenosis on the flap vessel and recipient vessel, pre- and post-bifurcation. 9/38 models represented ETE anastomoses, rather than ETS, with varying vessel diameters. 4/38 models represented ETE anastomoses with varying regions and levels of stenosis. Results: Stasis of blood flow in ETS models increased as anastomotic angle increased in a logarithmic relationship (R2 = 0.918). Flow was optimized overall as flap and recipient vessel diameters approached one another. In ETS models, flap vessel and post-bifurcation recipient vessel stenosis was found to substantially increase stasis. Conclusions: Selection of flap and recipient vessels with similar diameters can optimize outcomes in microvascular anastomoses. In the context of lower extremity reconstruction with the ALT flap, the PT artery can be recommended as a first-line recipient vessel due to its similar vessel caliber to the LCF and relative ease of surgical access compared to the P artery. Avoidance of areas of stenosis is recommended to ensure laminar flow and reduce operative difficulty associated with performing anastomoses on nonpliable arteries. Striving for increased acuity of anastomotic angles is recommended to optimize flow in ETS microvascular anastomoses.

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Corrigendum to “Analysis of multiple risk factors affecting the result of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes mellitus” [J Plast Reconstr Aesthet Surg 67 (2014) 624–628]

Cited by 2 publications

References 0 publications

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Outcomes and Risk Factors in Microsurgical Forefoot Reconstruction

Lower Extremity Reconstruction with Anterolateral Thigh Free-Flap Anastomoses: A Computational Fluid Dynamic Analysis

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