Orthoplastic Approach to Lower Extremity Reconstruction

Steinberger, Zvi; Therattil, Paul J.; Levin, L. Scott

doi:10.1016/j.cps.2020.12.007

Cited by 11 publications

(6 citation statements)

References 18 publications

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“…They named their approach "neuroplastic surgery". In lower extremity reconstruction, the orthoplastic approach has been well established [43,44]. It uses periodic, interdisciplinary team meetings to facilitate a closer collaboration of orthopedic, trauma, vascular, and plastic surgeons enabling the best possible care for patients with extremity defects.…”

Section: Discussionmentioning

confidence: 99%

Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience

Strübing

Wenz

Etminan

et al. 2023

JCM

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Background: Complex scalp defects are regularly reconstructed using microvascular tissue transfer. The latissimus dorsi free flap is one of the workhorse flaps used in scalp reconstruction. These cases necessitate, particularly in the elderly, a close cooperation between plastic surgeons and neurosurgeons. The purpose of this study was to evaluate the suitability of the latissimus dorsi free flap for complex scalp reconstructions and to analyze potential risk factors. Methods: A retrospective study identified 43 patients undergoing complex scalp reconstruction using a latissimus dorsi free flap at our department between 2010 and 2022. Results: The mean patient age was 61 ± 18 years. Defects were mostly caused by oncologic tumor resections (n = 23; 55%), exposure to a cranioplasty (n = 10; 23%) or infection (n = 4; 9%). The most frequent recipient vessels were the superficial temporal artery (n = 28; 65%), external carotid artery (n = 12; 28%) and the venae comitantes (n = 28; 65%), external jugular vein (n = 6; 14%). The reconstructive success rate was 97.7%. There was one total flap loss (2%). Partial flap loss occurred in five cases (12%). Follow-up was 8 ± 12 months. Major complications were seen in 13 cases, resulting in a revision rate of 26%. Multivariate logistic regression identified active tobacco use as the only risk factor for major complications (odds ratio 8.9; p = 0.04). Conclusion: Reconstruction of complex scalp defects using the latissimus dorsi free flap yielded high success rates. Among the potential risk factors, active tobacco use seems to affect the outcome of complex scalp reconstructions.

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Section: Discussionmentioning

confidence: 99%

Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience

Strübing

Wenz

Etminan

et al. 2023

JCM

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“…The traditional approach to reconstructing lower limb soft tissue wounds follows the ‘reconstructive ladder’ to improve functional outcomes and reduce the need for amputation [ 5 ]. However, the ‘reconstructive elevator’ proposed by Gottlieb and Krieger has been adopted by many colleagues in Ukraine and allows surgeons to choose the optimal method at the first operation [ 1 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

Telemedicine support aids lower limb reconstruction after combat injury in Ukraine

Хоменко

Лурін

Гуменюк

et al. 2023

Journal of Surgical Case Reports

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Since the destructive and illegal full-scale invasion of Ukraine in February 2022, caring for the victims of war trauma has been an essential function of Ukrainian clinicians [ 1, 2]. The authors present a case where using novel dynamic digital thermography (DDT), combined with international telemedicine support, contributed to saving the lower limb of an injured Ukrainian soldier. A male soldier in his 30s presented with a ‘through and through’ fragmentation wound to the right thigh from an artillery shell exploding nearby. After initial haemorrhage control and resuscitation, the patient was transferred to a tertiary hospital. Using telemedicine support, reconstructive surgery was planned and performed successfully using a perforating flap technique. DDT was used pre-operatively to identify a perforating vessel and post-operatively to ensure perfusion of the flap. The patient made a good recovery and was discharged 14 d post-operatively.

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“…Another limitation is the availability of complex reconstructive procedures, primarily accessible in hospitals with qualified microsurgeons and established microsurgical facilities. Establishing ongoing collaborations between orthopedic and plastic surgery units, along with the development of cooperative centers adopting an orthoplastic approach, holds promise for extending assistance to a larger patient population in the future [32,33].…”

Section: Study Limitationsmentioning

confidence: 99%

Exploring the Role of Free Tissue Transfers in the Preservation of Bone Length and Knee Joint Function after Lower Limb Trauma: A Retrospective Analysis

Krześniak,

Hsu,

Chen

et al. 2024

JPM

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Lower limb trauma often results in mangled extremities, and in some cases, complete amputation may be necessary. However, limiting the extent of amputation and preserving the major knee joint are crucial to enhance mobility and overall functionality. By providing painless soft tissue coverage on the stump, early prosthesis use and the initiation of physiotherapy become more feasible. Soft tissue transfers hold the potential to benefit patients in two essential aspects: first, resolving soft tissue deficiencies without causing bone shortening, and second, preparing the stump to enhance overall functionality. A retrospective study conducted at Chang Gung Memorial Hospital (2009–2016) focused on lower limb amputation patients who underwent soft tissue transfers at different time periods compared to those without stump reconstruction. Out of the 2391 cases of lower limb injuries treated operatively, 117 amputations were performed in 110 patients (44 above the knee and 73 below the knee). Among them, 12 patients received soft tissue transfers for limb salvage and soft tissue deficiency after amputations. It was observed that patients in this group were typically younger, predominantly female, had longer hospital stays, and underwent a greater number of surgical procedures (p < 0.05). Through the use of soft tissue transfers, successfully preserved tibial bone length and functional knee joint in selected patients was achieved. This approach effectively resolved soft tissue deficiencies following lower limb amputations, optimizing physiotherapy and facilitating functional rehabilitation.

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Orthoplastic Approach to Lower Extremity Reconstruction

Cited by 11 publications

References 18 publications

Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience

Scalp Reconstruction Using the Latissimus Dorsi Free Flap: A 12-Year Experience

Telemedicine support aids lower limb reconstruction after combat injury in Ukraine

Exploring the Role of Free Tissue Transfers in the Preservation of Bone Length and Knee Joint Function after Lower Limb Trauma: A Retrospective Analysis

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