Lower Extremity Reconstruction with Vascularized Free-Tissue Transfer: 20 Years of Experience in the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

Abstract

Objective: The reconstruction of extensive soft-tissue defects in the lower extremity still poses a great challenge to plastic and reconstructive surgeons. The ideal approach is to achieve a proper soft-tissue coverage with a well-vascularized flap, which results in a durable weight-bearing surface and permits normal joint motion. This study aims to retrospectively analyze the outcomes of lower-extremity reconstruction with vascularized free-tissue transfer performed at our plastic surgery division. Materials and Methods: A retrospective chart review was performed regarding 58 patients with defects in the lower extremity which were reconstructed with vascularized free-tissue transfers between 2000 and 2019. Forty-four of the patients were male, and 14 were female. The mean age was 44.4 years (range: 6-89 years). The most common indication for free-flap surgery was a secondary reconstruction after tumor eradication (23 cases, 39.7%), and 84.8% of the defects were exposed bare bones, tendons, or joints.Results: In our 58 reviewed cases, the foot was the most common area requiring reconstruction with a free flap (68.9%), and the mean defect size was 12.5 x 8.1 cm. The most commonly used free flap was the Anterolateral thigh free flap (39.7%), followed by the Gracilis free flap (29.3%), and the Superficial circumflex iliac artery-perforator free flap (10.4%). The recipient vessels most frequently used were posterior tibialis vessels (53.4%). The overall flap-survival rate was 75.9%, though there was an increased survival rate of up to 85.7% in the last five years of the period studied. The flap-salvage rate was 40.9%, and arterial thrombosis was the major cause of flap loss (50%). Factors associated with free-flap failure were re-exploration and free flap surgery after tumor or cancer eradication. The most common post-operative complication was flap-wound dehiscence (10.3%). Two patients received a flap correction due to bulkiness, and three had recurrence of ulceration. Conclusion: Microvascular free-tissue transfers for lower- extremity-defect reconstructions are reliable and valuable as a surgical technique. In over 20 years of experience in our division, we’ve had an overall flap-survival rate of 75.9%. Our flap of choice was the Anterolateral thigh free flap.

Sensory and Functional Recovery after Suprafascial Free Flap in Foot and Ankle Reconstruction

“…28 Despite the very low case number, the results might suggest that suprafascial free flap approach is safe and does not produce any negative effects to flap survival. 21 Moreover, in the present study, no serious complication or recurrent ulcer was observed or reported. As in published literatures, the suprafascial flaps yield is a safe and effective choice for soft tissue reconstruction of foot and ankle.…”

“…Most of the flaps inset since that time successfully survived, but the sufficiency of sensory recovery and functional outcomes is still being questioned. 21 Narushima, et al 22 recently published a classification of thin flaps that is based on the anatomical plane of dissection. Hong and Chung 23 demonstrated the safely plane of flap dissection at the plane of superficial fascia which refers to thin flaps as we called today ( Fig.…”

Deep Peroneal Nerve: From an Anatomical Basis to Clinical Implementation

“…Nowadays, the clinical procedures implicated with this nerve can widely range from noninvasive ones, e.g., nerve imaging, to sophisticated surgical approaches, such as flap transfer for the reconstruction of a lower extremity, which have been regularly conducted in specialized clinical institutes. 88 This review therefore linked the fundamental anatomy of this nerve to its practical importance visualized in the examples of current clinical applications reviewed in this study by the main focus on its practicality and utilization. This review therefore presented the usefulness of translational research in this area for clinical implementation.…”

Deep Peroneal Nerve: Orientation and Branching at the Ankle and Proximal Part of the Foot

“…nerve block 25,26 , nerve stimulation and conduction study 27,28 , surgical nerve transfer 29 and flap surgery for lower extremity reconstruction which is commonly operated on in a tertiary-care center. 30 In addition, another useful aspect is to minimize iatrogenic injuries of structures surrounding the DPN during certain procedures such as ankle arthroscopy and surgery in the ankle and foot areas. 31 Likewise, certain natures of the…”