Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue

Boffeli, Troy J.; Waverly, Brett J.

doi:10.1053/j.jfas.2014.12.007

Cited by 11 publications

(6 citation statements)

References 13 publications

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“…Good-quality evidence is available to support practices relevant, although not exclusive, to DFO management, such as the randomized trials on various offloading modalities for foot ulcers ( 18 – 21 ). Furthermore, several authors have published a case series describing good outcomes with surgical techniques that can be applied to appropriately selected patients with DFO ( 22 – 25 ). Unfortunately, there is very little evidence to support many of the most basic aspects of surgical management, such as how to determine the extent of bone that should be resected determined, whether surgical wounds should be closed or left open, and whether is it useful to obtain a bone margin specimen for culture or histology to guide postoperative management.…”

Section: Discussionmentioning

confidence: 99%

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

Allahabadi

Haroun

Musher

et al. 2016

Diabetic Foot & Ankle

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BackgroundThe aim of this study was to develop consensus statements that may help share or even establish ‘best practices’ in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data.MethodsWe asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0.ResultsThe panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists’ agreement on general principles for surgical management of DFO.ConclusionsConsensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as ‘best practice’ guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO.

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Section: Discussionmentioning

confidence: 99%

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

Allahabadi

Haroun

Musher

et al. 2016

Diabetic Foot & Ankle

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“…The initial search identified 53 eligible studies. 4-56 After applying the inclusion and exclusion criteria, 28 studies were excluded. Nine studies were excluded because they were performed on foot wounds in patients without diabetes mellitus *.…”

Section: Resultsmentioning

confidence: 99%

Use of Local Flaps for Soft-Tissue Closure in Diabetic Foot Wounds: A Systematic Review

Ramanujam¹,

Zgonis²

2018

Foot & Ankle Specialist

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“A systematic review was undertaken to assess the outcomes of local random flaps in diabetic foot wound closure. The review was conducted using the following databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica dataBASE, Google Scholar, MEDLINE, Ovid, and PubMed. Search terms were local random flap, diabetes, foot, wound, ulceration, neuropathy, tissue transfer, V-Y, bilobed, monolobed, rotational, advancement, transpositional, rhomboid, and Limberg. English language studies, studies published from 1997 to 2017, patients with diabetes mellitus treated for foot wounds, use of local random flaps, follow-up period of 6 months or more postoperatively, documentation of healing rates, complications, and need for revisional surgery were included. Isolated literature reviews and descriptions of only surgical technique and/or cadaveric studies were excluded. The initial search identified 53 eligible studies with 28 being excluded. The remaining 25 studies used for data extraction had a total of 512 patients in which 199 of these underwent 204 local random flap procedures. Average follow-up for the flaps was approximately >2 years, and successful wound closure at last follow-up was demonstrated in 75.5% of the studied population. Studies were found to be of generally low quality, with the majority composed of retrospective case series. Based on current available evidence found in this systematic review, local random flaps demonstrated a relatively high success rate when utilized for the definitive closure of diabetic foot wounds. However, because of a lack of high-quality evidence and substantial heterogeneity among the studies, the results should be interpreted with caution. Levels of Evidence: Level III: Systematic review

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“…After transmetatarsal resection, advancement of plantar tissue within the angiosome of either the medial or lateral plantar artery can provide immediate soft-tissue coverage. 8 Previous studies have also reported good outcomes with filleted flaps of the amputated toes or rays ("spare parts" method) for coverage of the TMA stump. 17,[31][32][33] In this technique, viable skin and soft tissue, which would otherwise be discarded after TMA, are used for soft-tissue coverage of the TMA stump.…”

Section: Discussionmentioning

confidence: 98%

“…Compared with a more proximal LE or foot amputation, TMA preserves limb length and provides improved biomechanical function of the foot, resulting in favorable long-term morbidity and mortality outcomes. 7,8 Furthermore, functional gait can be preserved without need for a prosthesis. [9][10][11] One important factor that determines the amputation level is the availability of locoregional soft tissue to cover the stump.…”

mentioning

confidence: 99%

The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations

Deldar

Sayyed

Cach

et al. 2023

Plastic &Amp; Reconstructive Surgery

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Background: Chronic lower extremity wounds affect up to 13% of the US population. Transmetatarsal amputation (TMA) is frequently performed in patients with chronic forefoot wounds. TMA allows limb salvage and preserves functional gait, without need for prosthesis. Traditionally, when tension-free primary closure is not possible, a higher-level amputation is performed. This is the first series to evaluate the outcomes of local and free flap coverage of TMA stumps in patients with chronic foot wounds. Methods: A retrospective cohort of patients who underwent TMA with flap coverage from 2015 through 2021 was reviewed. Primary outcomes included flap success, early postoperative complications, and long-term outcomes (limb salvage and ambulatory status). Patient-reported outcome measures using the Lower Extremity Functional Scale (LEFS) were also collected. Results: Fifty patients underwent 51 flap reconstructions (26 local, 25 free flap) after TMA. Average age and body mass index were 58.5 years and 29.8 kg/m 2 , respectively. Comorbidities included diabetes [n = 43 (86%)] and peripheral vascular disease [n = 37 (74%)]. Flap success rate was 100%. At a mean followup of 24.8 months (range, 0.7 to 95.7 months), the limb salvage rate was 86.3% (n = 44). Forty-four patients (88%) were ambulatory. The LEFS survey was completed by 24 surviving patients (54.5%). Mean LEFS score was 46.6 ± 13.9, correlating with 58.2% ± 17.4% of maximal function. Conclusions: Local and free flap reconstruction after TMA are viable methods of soft-tissue coverage for limb salvage. Applying plastic surgery flap techniques for TMA stump coverage allows for preservation of increased foot length and ambulation without a prosthesis.

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Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue

Cited by 11 publications

References 13 publications

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

Consensus on surgical aspects of managing osteomyelitis in the diabetic foot

Use of Local Flaps for Soft-Tissue Closure in Diabetic Foot Wounds: A Systematic Review

The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations

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