Abstract:Background Lower extremity defects often require free tissue transfer due to a paucity of local donor sites. Locoregional perforator-based flaps offer durable, single-stage reconstruction while avoiding the pitfalls of microsurgery. Multiple harvest techniques are described, yet few studies provide outcome comparisons. Specifically, no study has examined the impact of perforator flap pedicle skeletonization on reconstructive outcomes. This systematic review characterizes technique and impact of pedicle skeleto… Show more
“…This includes examining the circumstances surrounding the wound, such as the energy involved at the time of injury, initial diagnosis, fracture type, Gustilo classification, initial wound management status, and duration of wound openness, among others [ 16 , 23 ]. Surgical techniques should be executed with care, with particular attention paid to pedicle dissection and rotation [ 22 ]. Although evaluating angiosomes post-trauma poses challenges [ 16 ], reports recognize the ability to objectively assess skin flap viability using intraoperative indocyanine green [ 28 , 36 ].…”
Section: Discussionmentioning
confidence: 99%
“…After circumferentially dissecting the skin flap, the perforator was fully dissected toward the major artery. As reported by Soteropulos et al [ 22 ], when the rotation angle was large, the perforator was skeletonized to prevent twisting of the vascular pedicle during flap rotation. We visually assessed the flap colour and capillary refilling to evaluate intraoperative blood flow.…”
Background
The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction.
Methods
We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis.
Results
The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases.
Conclusions
Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction.
Data access statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
“…This includes examining the circumstances surrounding the wound, such as the energy involved at the time of injury, initial diagnosis, fracture type, Gustilo classification, initial wound management status, and duration of wound openness, among others [ 16 , 23 ]. Surgical techniques should be executed with care, with particular attention paid to pedicle dissection and rotation [ 22 ]. Although evaluating angiosomes post-trauma poses challenges [ 16 ], reports recognize the ability to objectively assess skin flap viability using intraoperative indocyanine green [ 28 , 36 ].…”
Section: Discussionmentioning
confidence: 99%
“…After circumferentially dissecting the skin flap, the perforator was fully dissected toward the major artery. As reported by Soteropulos et al [ 22 ], when the rotation angle was large, the perforator was skeletonized to prevent twisting of the vascular pedicle during flap rotation. We visually assessed the flap colour and capillary refilling to evaluate intraoperative blood flow.…”
Background
The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction.
Methods
We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis.
Results
The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases.
Conclusions
Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction.
Data access statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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