Plantare neurovaskuläre Filetlappenplastik

Abstract

Sensory denervation is the key factor for the high rate of recurrent sacral pressure sores in paraplegic patients. This paper summarizes the results after reconstruction of recurrent sacral pressure sores using a sensory innervated plantar fillet free flap. Five plantar fillet free flaps were utilized for defect reconstruction of sacral pressure sores in five male patients during a 9-year period (1989-1998). Data were analyzed retrospectively. Patients'age ranged between 32 and 51 years. The level of spinal cord injury was between T10 and L1. The average defect size was 20 x 16 cm. All flaps were microsurgical free tissue transfers. The posterior tibial nerve was coapted to two intercostal nerves from above the spinal cord injury level. All patients developed sensation within 3-6 months. A stable sensate coverage was achieved in each case. The data show that the concept of a sensory innervated plantar fillet free flap may facilitate defect reconstruction in most complex or even seemingly hopeless cases.

Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding

“…[22][23][24][25][26][27] In a few cases, this flap was used as a free flap with sensation for the repair of isolated ischial and sacral pressure sores. 19,20 In complex stage IV pressure sore repair with a lower-extremity fillet flap, the foot is generally sacrificed because the thigh and leg tissues are sufficient to cover the lesions. Although patients with paraplegia and low-level spinal cord injuries who are able to sit and use a wheelchair experience increased pressure, particularly on the ischial region, these patients can change their position while awake independently or with assistance to avoid unwanted pressure.…”

“…The plantar part of the foot is most often used as a pedicled and free plantar flap to repair amputation stumps after above- and below-knee amputations 22–27 . In a few cases, this flap was used as a free flap with sensation for the repair of isolated ischial and sacral pressure sores 19,20 . In complex stage IV pressure sore repair with a lower-extremity fillet flap, the foot is generally sacrificed because the thigh and leg tissues are sufficient to cover the lesions.…”

“…2,6,[9][10][11][12][13][14][15][16][17] A foot fillet flap can be used alone or as part of the total lower-extremity fillet flap in pressure sore repair. 15,[18][19][20] Considering the unique pressure absorption and redistribution properties of the plantar part, the foot is used as a pedicled or free foot fillet flap in the repair of amputation stumps. 18,[21][22][23][24][25][26][27] Owing to these properties, the plantar part of the foot can be used for prophylactic purposes in patients with paraplegia to strengthen areas that are subjected to high pressure and prone to the development of pressure sores.…”

Reconstruction of Below Knee Stump with Free Plantar Fillet Flap: A Case Report

“…There are few studies in the literature in which plantar fillet flap is used as a free flap and has been reported. In 2003, Küntscher et al 6 and in 1995, Goldberg et al 7 performed free plantar fillet flap to repair sacral decubitis ulcers in paraplegic patients. In addition, the outcomes of 8 patients who underwent foot fillet flap were presented by Tos et al 8 that two of 8 patients were traumatic amputations.…”

Refrakturen nach Entfernung von Osteosynthesematerialien, eine vermeidbare Komplikation?

“…Mit Zunahme der operativen Stabilisierung von Knochenbrüchen am Bewegungsapparat wurde bereits früh die Frage der Notwendigkeit der Implantatentfernung und der Gefahr von Refrakturen diskutiert [3]. Namhafte Chirurgen befassten sich mit dem Problem der Materialentfernung als solches [4] und den möglichen Komplikationen [5]. Schon früh wurden Richtlinien bez.…”