The Efficacy of Perforator Flaps in the Treatment of Chronic Osteomyelitis

Hong, Joon Pio; Goh, Terence; Choi, Donghoon; Kim, Jung Jae; Suh, Hyun Suk

doi:10.1097/prs.0000000000003460

Cited by 51 publications

(52 citation statements)

References 40 publications

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“…Reconstruction can be complex applying combine flaps to obliterate the dead space, reconstruct the bone defect, and resurface the skin defect. With a multidisciplinary approach using proper antibiotics and a surgical approach, the recurrence rate after reconstruction was 8.3%, the primary remission rate was 91.6%, the secondary remission rate was 98.3%, and the amputation rate was 1% in our series . Significant predictors of recurrence were peripheral vascular disease and major vessel compromise, which had 5.1 times higher odds of recurrence …”

Section: Surgical Techniquesmentioning

confidence: 60%

“…When considered for microsurgical reconstruction, the wound preparation process may easily be overlooked. However, preparing the wound adequately addressing vascularity, infection, dead space, and stability of the skeletal structure will lead to a better outcome …”

Section: Patient Selection Multidisciplinary Approach and The Woundmentioning

confidence: 99%

“…One of the basic elements of plastic surgery is to replace like with like. Thus for defects with skin defects, we are shifting towards using perforator flaps such as anterolateral thigh (ALT) perforator flap, thoracodarsal artery perforator (TDAP) flap, and superficial circumflex iliac perforator (SCIP) flap as it provides, a thin flap to minimise shearing, can take only the superficial fat to imitate the fibrous septa of the sole to adhere tightly, enhance neovascularisation of the subdermal plexus with adjacent tissue, and provide adequate blood supply to fight infection . The elevation technique of each individual flap is described in detail in the referenced articles.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…In chronic osteomyelitis, our experience of microsurgical reconstruction using perforator flaps showed a flap survival of 95.8% . The treatment has similar principles that require aggressive surgical debridement removing all fibrotic and ischaemic bone and soft tissue surrounding the wound that impedes antibiotic delivery followed by definitive reconstruction with the objective of restoring ambulatory function .…”

Section: Surgical Techniquesmentioning

confidence: 99%

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The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

Suh

Hong

2019

International Wound Journal

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Frequently considered chronic wounds for reconstruction are wounds lacking healing progress despite good wound care. And those needing microsurgical reconstruction are chronic wounds that are unable to close by local flap or skin grafts, wounds with exposed vital structure such as tendon and bones, and wounds that have prolonged infections such as osteomyelitis and skin necrosis. The reconstruction for soft tissue defects not only aims to provide coverage but to restore function and acceptable form as well. Wound preparation prior to microsurgical reconstruction consists of improving or restoring vascular supply, stabilising skeletal structures, and obtaining clinically clean wounds. Microsurgery is a surgical discipline that combines magnification with a advanced microscope, specialised precision tools, and various operating techniques. Thus microsurgery allows flap to be transferred far from the donor site restoring form and function to areas of the body that have lost skin, fat, muscle movement, and/or skeletal support. Microsurgery has expanded reconstructive surgery's elements and strategies and is still evolving.Along with the multidisciplinary approach and good principle of wound care, the repair and restoration strategies using microsurgery have widened the possibilities for limb salvage from complex chronic wounds.

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Section: Surgical Techniquesmentioning

confidence: 60%

Section: Patient Selection Multidisciplinary Approach and The Woundmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

Section: Surgical Techniquesmentioning

confidence: 99%

See 2 more Smart Citations

The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

Suh

Hong

2019

International Wound Journal

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“…Staphylococcus aureus is the most common pathogen found in chronic osteomyelitis. Radical debridement by surgery is a crucial step where particular attention should be paid because large bone defects are created following radical debridement (16). Therefore, reconstruction of bone defects is another key challenge in treating chronic osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

Masquelet induced membrane technique for treatment of rat chronic osteomyelitis

Cui

Peng

et al. 2018

Exp Ther Med

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The application value of Masquelet induced membrane technique for the treatment of rat chronic osteomyelitis was explored. A total of 180 male Sprague-Dawley (SD) rats were randomly divided into sham operation group (control group), chronic osteomyelitis model group (model group) and Masquelet induced membrane therapy + chronic osteomyelitis model group (observation group); 60 rats in each group. A rat model of traumatic osteomyelitis was established using a modified blunt trauma method in model and observation group. All rats in observation group were treated with membrane induction technology while in the control group they were not. Postoperative complications, bone healing time and functional status of the affected limbs were recorded. After surgery, no obvious perioperative complications occurred in most of the rats, except that 5 rats experienced partial necrosis at the edge of the flap, and 3 experienced superficial infection around the incision site in the ilium. Primary bone healing was achieved in 50 rats with an average healing time of 15 weeks. Among them, 38 rats restored weight-bearing function after 20 weeks. Seven rats experienced infection after surgery, but complete bone healing was achieved after treatment with induced membrane technique again. Following treatment with induced membrane technique, the rat body weight, body temperature and the number of bacteria in the wound decreased over time. In conclusion, Masquelet induced membrane technique is effective for the treatment of large bone defects in rats after traumatic osteomyelitis. This technique significantly shortens the treatment cycle. The surgical procedure is simple, and the incidence of postoperative complications is low.

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Versatile design of compound vastus lateralis muscle and anterolateral thigh musculocutaneous perforator free flaps for customized reconstruction of complex skin and soft tissue defects in the extremities

Zhou

et al. 2020

Microsurgery

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Background: Compound anterolateral thigh flaps are popular for three-dimensional reconstruction of complex soft tissue defects. We present our 10-year experience using compound vastus lateralis (VL) muscle and anterolateral thigh musculocutaneous perforator (ALTP) flaps, and introduce three versatile customizations of this flap for individualized reconstruction of complex threedimensional soft tissue defects. Methods: From May 2008 to June 2017, compound VL muscle and ALTP flaps were performed in 67 consecutive patients aged 14-75 years (62 men and 5 women). The defects were in either the lower (n = 53) or upper extremity (n = 14), and ranged in size from 8 × 4 cm 2 to 25 × 6 cm 2. Dead space volume ranged from 4 × 2 × 1 cm 3 to 20 × 3 × 2 cm 3 , and all flaps were harvested from patients' thighs as one of three types. In type A, a single perforator supplied both the skin and muscle components, with the vascular bundle penetrating the muscle component. In type B, a single perforator supplied both skin and muscle components with separate branches to the skin and muscle. In type C, separate vessels supplied the skin and muscle. Results: In the 67 patients, 65 flaps survived, and the donor site was closed directly. Vascular compromise occurred in four patients on the first postoperative day. Two flaps were salvaged after emergency re-exploration. Flap loss occurred in two patients, and these defects were repaired using other flaps. The follow-up period ranged from 8 to 60 months (mean, 11.9 months). All flaps had satisfactory appearance and texture, and no patients experienced limited hip and knee joint mobility from the donor site operation. Conclusions: Compound VL muscle and ALTP flaps are a reliable option to reconstruct complex defects of the extremities. Identifying three flap types allowed for more precise customization to cover complex defects with limited donor site morbidity.

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The Efficacy of Perforator Flaps in the Treatment of Chronic Osteomyelitis

Abstract: Therapeutic, IV.

Cited by 51 publications

References 40 publications

The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

The role of reconstructive microsurgery in treating lower‐extremity chronic wounds

Masquelet induced membrane technique for treatment of rat chronic osteomyelitis

Versatile design of compound vastus lateralis muscle and anterolateral thigh musculocutaneous perforator free flaps for customized reconstruction of complex skin and soft tissue defects in the extremities

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