Neurocutaneous flaps for soft tissue reconstruction of the knee, lower leg, ankle and foot: Clinical experience with 32 patients

Abstract

Background/Aim. Neurocutaneous flaps (NF) are the type of fasciocutaneous flaps whose clinical application has increasingly grown over the years. They have become an indispensable step in the reconstructive ladder for the small and medium soft tissue defects of the lower leg and foot. The aim of this study was to analyse the results of the treatment of patients with lower extremity soft tissue defects caused by trauma, infection, tumour removal or unstable scar formation, which were reconstructed with a variety of NF. Methods. This retrospective study includes 32 consecutive patients with soft tissue defects of the lower limb, treated in the Clinical Centre of Vojvodina from January 2004 to April 2017. All the operations were performed in regional anaesthesia with pneumatic tourniquet. Design of the flap and length of the pedicle were determined by the size and position of the recipient site after necessary debridement. The flap was harvested, rotated and positioned in the defect region. The patients and flap data were summarized upon their collection. Results. The average age of the patients, mostly males (81.2%), was 46.7 years. Distally based sural flaps were used in a majority of patients (56.2%), followed by the distally based saphenous (21.9%), lateral sural (12.5%) and proximally based sural flaps (9.4%). Defects were most often localized on the distal third of the lower leg and on the ankle (53.1%). The most common indication for surgery were trauma (46.9%) and chronic infection (31.2%). A satisfactory coverage of the defect was achieved in all 32 patients with no flap loss. A partial necrosis of the flap due to prolonged venous congestion was noted in 3 (9.4%) patients, which were healed by second intention or with delayed skin grafting. Five (15.6%) patients developed a localised infection. The infection signs withdrew spontaneously in 2 cases and after a surgical revision in 3 cases, where osteitis of the tibia had persisted. One of them required the Ilizarov orthopaedic procedure after bone resection. Conclusion. NF proved to be a paramount alternative to free-flap reconstruction of the lower limb. Intensive clinical application can be explained by the fact that it is a less technically demanding and time consuming surgical procedure with no major source vessel sacrifice. The reliability and safety of their utilisation are confirmed by our clinical data.

Versatile clinical application of radial artery perforator flap for hand and wrist reconstruction

“…This is recommended to reduce tunnel tightness and to avoid traction injury. Numerous authors believe that these procedures can reduce the risk of possible complications 12,14,15 .…”

“…After elevation to the pivot point, the flap is rotated for 180 degrees to reach the distal defect through the subcutaneous tunnel. In the case of a larger flap or a rich layer of subcutaneous adipose tissue, the intervening skin bridge between the defect and the pivot point should be opened and after passing the flap subsequently closed 12 . Direct closure of the donor site can be achieved if the width of the defect does not exceed 4-5cm, otherwise a split skin graft is required.…”

Versatility of Reverse Sural Artery Flap for Coverage of Heel and Proximal Foot Defects in Children

“…9 The reverse sural flap in addition to its many advantages is also associated with some complications like venous congestion, partial or total flap failure, ugly looking scar at donor site, and sensory problems. 2,3, 8 In adult patients post-traumatic soft-tissue defects are the main indication but in children the use of this flap has not been well evaluated. The aim of this study was to determine the versatility of reverse sural artery flap in terms of its reliability and efficacy for the coverage of proximal foot and heel defects in children.…”