Reconstruction of plantar defects

Abstract

Abstract. Plantar defects are a challenge for the plastic surgeon; from 1984-1995 59 operations were performed in 57 patients. The radial forearm flap and the latissimus dorsi (LD) flaps were mainly used depending on the amount of tissue loss. Local flaps such as dorsalis pedis and instep flaps were used for smaller defects. The radial forearm flap is ideal in terms of thickness and stability for the sole but limited in its size. The LD flap is a safe procedure especially for severe injuries and osteitis, but has the disadvantage of being bulky and debulking procedures are frequently performed. For nerve reconstruction deep sensibility seems to be sufficient in order to obtain stable postoperative results. In this report the different operative methods are evaluated. Since 1991, the patients were monitored with static and dynamic foot pressure measurements and gait analysis to assess the postoperative result and prevent pressure ulcers, scar irritation and hyperkeratosis. Preoperative investigations may contribute to an optimal schedule for planning and stabilization of the operative regimen. Key words: Plantar defects -Soft tissue defects - Weight-bearing pattern -Dynamic footprintThe sole of the foot is unique in the human body in terms of anatomy and function [13]. Pressure and shearing forces affect this region. Plantar defects occur after trauma, due to trophic ulceration or neurogenic disturbances. Systemic diseases such as diabetes mellitus, arteriosclerosis or immunological disorders may complicate the therapeutic regimen. Interdisciplinary management is mandatory.Operative techniques depend on numerous factors: first, the amount of tissue injury, size, depth and location of the defect; second, the size of bone defects with or without soft tissue cover; third, the degree of contaminaCorrespondence to: J. Liebau, Clinic of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Podbielskistrasse 380, D-30659 Hannover, Germany tion. The variety of surgical procedures includes skin transplantation, local flaps, pedicle flaps, free flaps, and even now the cross leg flap, which is sometimes used in young patients [6,14]. As far as the sensation of the transferred tissue is concerned, deep sensation seems to be sufficient to ensure a stable postoperative result [15,21]. Postoperative monitoring with foot pressure measurements and gait analysis can help to stabilize the result of the operative treatment. A large retrospective series is presented in order to demonstrate the indications and outcome of different surgical procedures. Material and methodsFrom 1984 to 1994, 59 operations were performed in 57 patients with plantar defects (age: 18 to 71 years). The following flaps were used: radial forearm, myocutaneous LD, scapular, upper lateral arm, dorsalis pedis, instep and cross leg flaps. The only neurovascular flaps were the instep flap and the dorsalis pedis flap. Two radial forearm flaps had to be changed to dorsalis pedis flaps, one due to postoperative vascular problems, one due to infection half...

A Crystalline, Large‐Pore, Microporous Semiconductor

“…Similar to the case of cetineites [1][2][3][4]10] and K-SBC-1, [5] the {Sb 18 O 27 } tubes are presumably stabilized by the strong SbÀO bonds, whereas the overall structure is held together by ionic forces between the negatively charged {SbTe 3 } 3À pyramids and Te 2 2À dumbbells in the tubular interstices, and the rubidium counter cations lined on the inside of the {Sb 18 O 27 } tubes.…”

“…[1] A variety of additional synthetic cetineite-type phases also reveal optical band gaps in the visible range and electrical semiconductivities. [2] Experimental results [1,3] and theoretical computations [3] have demonstrated that the optical band gaps of the members of the cetineite family with the general formula A 6 [Sb 12 O 18 ][SbX 3 ] 2 (A = K or Na, X = S or Se) vary with the composition of the crystal and tend to decrease with increasing atomic number of both the alkali metal and the chalcogen. It was suggested that these properties may be attributed to an overlap of the sp, d xz , and d yz orbitals of the Sb atoms of chemically different subunits (namely the {Sb 12 O 18 } tubular unit and the {SbS 3 } 3À or {SbSe 3 } 3À pyramids) in an alternating sequence along the crystallographic c axis.…”

“…Although unique in its configuration, the outer network consists of well-known building blocks. The trigonal pyramidal {SbTe 3 } 3À anions are found, for example, in clathrates, such as Na 3 SbTe 3 [7] and K 3 SbTe 3 , [8] and interestingly enough, pyramidal {SbS 3 } 3À and {SbSe 3 } 3À anions have been found in the cetineite structure, [1][2][3][4] although the {SbTe 3 } 3À anion has not. The Sb À Te distance in the {SbTe 3 } 3À anions in Rb-CTH-1 is 2.726 , which is somewhat shorter than those in Na 3 SbTe 3 and K 3 SbTe 3 (2.783 and 2.787 , respectively).…”

Use of the SurroSense Rx System for Sensory Substitution of the Insensate Plantar Foot Resurfaced With Latissimus Dorsi Muscle Free Flap and Skin Graft

“…8 Optimal plantar reconstruction provides durable coverage with a favourable aesthetic, while enabling sufficient protective sensation to prevent pressure sores. 9 In the setting of significant tissue loss, especially of the heel, robust coverage is often achieved with skin-grafted muscle flaps, such as serratus, latissimus, and rectus femoris flaps. 10,11 Coverage with microvascular free tissue transfer has the advantage of providing abundant, healthy soft tissue in various thicknesses, depending on the size and location of the defect.…”

Novel Pressure-Sensing Smart Insole System Used for the Prevention of Pressure Ulceration in the Insensate Foot

“… 1 Optimal plantar reconstruction provides durable coverage with a favorable aesthetic and protective sensation to prevent pressure sores. 2 Coverage of lower extremity defects is often achieved with skin-grafted muscle or fasciocutaneous flaps. 1 Free flaps can be innervated to provide sensory feedback, though they have not been shown to be superior in durability and gait.…”