Suitability of the Scapular Flap for Reconstructions of the Foot

Rautio, Jorma; Asko‐Seljavaara, Sirpa; Laasonen, Leena; Härmä, Markku

doi:10.1097/00006534-199006000-00013

Cited by 39 publications

(25 citation statements)

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“…12,13 Furthermore, none of the skin grafted on muscles has significant cutaneous sensibility. 12 The scapular flap 14 provides an appropriate thickness for reconstruction of a weight-bearing area. However, when surgery on the main lesion is performed in a supine position, patient repositioning is required for flap harvest during the operation.…”

Section: Discussionmentioning

confidence: 99%

Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps

et al. 2006

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Soft-tissue reconstruction of the feet in diabetic patients with angiopathy, sensorial neuropathy, and immunopathy is a complicated problem. Until the mid-1980s, chronic foot ulcers in diabetic patients were treated conservatively, because flap surgery was regarded as too risky. However, in recent years, early debridement and flap coverage have become popular reconstructive methods for diabetic foot wounds. Several flap donor sites are available, depending on the nature of the defect. The deep inferior epigastric artery perforator (DIEP) flap is a relatively new flap that developed as a modification of the transverse rectus abdominis muscle (TRAM) flap. It provides a large amount of skin and subcutaneous tissue, without the donor-site morbidity of the ordinary TRAM flap. Furthermore, using the DIEP flap avoids the loss of major vessels. In this study, we report on the successful use of the DIEP flap in four cases of diabetic foot ulceration.

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Section: Discussionmentioning

confidence: 99%

Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps

et al. 2006

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“…Rautio et al used the scapular fasciocutaneous free flap for 13 large weight-bearing area reconstructions. 3 They mentioned that property tightening and making a good contour for the flap were important to avoid tissue abundance. They stated that there was no relation between soft-tissue stability and shear resistance.…”

Section: Discussionmentioning

confidence: 99%

“…The medial plantar flap has been regarded as a standard flap for plantar reconstruction because of its similar nature of soft tissue to weight-bearing area. 1 However, in case a large-sized defect at the plantar region is noted, a free muscle flap with skin graft 2 or a scapular fasciocutaneous free flap 3 is required to cover the defect.…”

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confidence: 99%

Change of weight‐bearing pattern before and after plantar reconstruction with free anterolateral thigh flap

et al. 2004

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We reconstructed a large-sized defect at the weight-bearing plantar region by a free anterolateral thigh flap successfully. This is the first case report of using the anterolateral thigh flap for reconstruction of the plantar foot. Based on the preoperative and postoperative pedogram examinations, the pressure distribution on the weight-bearing area reconstructed by the transferred flap was obviously improved and demonstrated a nearly normal pattern. No previous report has compared the weight-bearing pattern before and after large plantar reconstruction with a free flap. The anterolateral thigh free flap, which provides adequate bulk and contour of the foot, and which withstands weight pressure and shearing force and has the ability to provide recovery of sensation, is considered a good alternative in covering a large weight-bearing plantar defect.

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“…Mechanical resistance of this flap is limited [21]. The upper lateral arm flap is a flap with versatile properties.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors consider deep sensation to be sufficient [15,16,21,23]. Other authors argue that reconstruction of sensation is mandatory, as there would be no weight-bearing in areas without sensation, increasing the risk of recurrent ulceration [17,20].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of plantar defects

et al. 1997

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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...

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Suitability of the Scapular Flap for Reconstructions of the Foot

Cited by 39 publications

References 0 publications

Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps

Limb salvage of infected diabetic foot ulcers with free deep inferior epigastric perforator flaps

Change of weight‐bearing pattern before and after plantar reconstruction with free anterolateral thigh flap

Reconstruction of plantar defects

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