Traumatic Forefoot Reconstructions With Free Perforator Flaps

Zhu, Yaofeng; He, Xiaoqing; Wang, Yi; Liu, Qian; Fan, Xin-Yv; Xu, Yongqing

doi:10.1053/j.jfas.2015.04.019

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…Zgonis et al and Gözü et al utilized the cross-leg reverse sural artery ap to reconstruct the defects over the distal forefoot in small sample size [7,8]. However, it isn't an optimal choice because the prolonged postoperative immobilization of both lower limbs and the unavoidable reoperations is a great inconvenience for patients.Zhu et al reconstructed the defect over the forefoot using 5 types of free aps for 41 patients, and two aps were lost by repeat exploration [9]. Free ap can be used to reconstruct larger defects however the procedure has some disadvantages, such as time limitation, requirement of additional equipment, increased technical complexity, sacri cing of the main vessel, trained microsurgeons and teams, postoperative monitoring requirements, and the need for a relatively longer learning curve and there is always a risk of reexploration.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical treatment is di cult through covering the defect in this area;. The cross-leg ap [7,8], other pedicled or local ap [5], and free ap [9] can be used to reconstruct the defect over the distal forefoot, but each ap has its respective indications and limitations. The cross-leg ap for that reconstruction of the defects in the region is a safe alternative, however, the patients who receive the cross-leg ap require additional nursing care and unavoidable reoperations, and face di culties in daily activities.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

Peng

Luo

et al. 2020

Preprint

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Background Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, reports on the reconstruction of the defects over the distal forefoot using the DPAPF flaps are scarce. Herein, we describe our experience on the reconstruction of these defects using DPAPF flaps in a considerable sample size. Methods Between February 2005 and August 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. In order to reduce the length of fascial pedicle and the total length of the DPAPF flaps, the ankles were fixed in dorsiflexion using a Kirschner wire before designing the flaps. The flaps were elevated by the anterograde–retrograde approach. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups. Results Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 ± 0.58 cm, the total length of the flap was simultaneously shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from 3.0 cm to 6.0 cm. The fascial pedicle width > 4 cm was found in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top-edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05).Conclusions The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. By fixing ankle in dorsiflexion with Kirschner wire and widening the fascial pedicle appropriately, the top-edge and LWR of the flaps will be decreased, and thus the procedures are helpful for the flaps survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

Peng

Luo

et al. 2020

Preprint

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“…Large RSA flaps showed venous congestion leading to partial flap necrosis as studied by Grandjean et al 16 RSA flap, fasciocutaneous flaps, and perforator propeller flaps from the same limb reach up to the proximal or middle of the foot but not up to base of toes. 13 However, we can follow the reconstructive elevator and choose free flap reconstruction 17,18 when expertise and infrastructure are available. Li et al 19 have concluded that free flaps play a major role in reconstruction of complex, large distal defects of the foot and ankle than pedicled flaps in their comparative study.…”

Section: Discussionmentioning

confidence: 99%

Reverse Peroneal Artery Flap—A Workhorse Flap for Reconstruction of Large, Distal Defects of Ankle and Foot

Palukuri

Ireni

Jabbar

et al. 2022

Indian J Plast Surg

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Background Reconstruction of large foot and ankle defects is a difficult task due to less available local soft tissue and more critical from functional point of view. To overcome the limitations associated with locoregional flaps and free flaps, reverse peroneal artery (RPA) flap was selected and its usefulness in reconstruction of distal large defects of the ankle and foot and its complications were studied. Materials and Methods This is a prospective observational study done in 20 patients treated as cohort within 2 years and 8 months from January 2018 to August 2020. Large defects of foot and ankle were reconstructed with RPA flap and evaluated for its usefulness. Three cases were evaluated with computed tomography angiography postoperatively, to assess the vascular pattern. Conclusion RPA flap is a versatile and very reliable flap for the reconstruction of large and distal defects of foot and ankle. It is safely done in children and in acute trauma without any major complications.

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“…However, it is not an optimal choice because the prolonged postoperative immobilization of both lower limbs and the unavoidable reoperations is a great inconvenience for patients. Zhu et al reconstructed the defect over the forefoot using 5 types of free flaps for 41 patients, and two flaps were lost by repeat exploration [9]. Free flap can be used to reconstruct larger defects; however, the procedure has some disadvantages, such as time limitation, requirement of additional equipment, increased technical complexity, sacrificing of the main vessel, trained microsurgeons and teams, postoperative monitoring requirements, and the need for a relatively longer learning curve, and there is always a risk of reexploration.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical treatment is difficult through covering the defect in this area. The cross-leg flap [7,8], other pedicled or local flap [5], and free flap [9] can be used to reconstruct the defect over the distal forefoot, but each flap has its respective indications and limitations. The cross-leg flap for that reconstruction of the defects in the region is a safe alternative; however, the patients who receive the crossleg flap require additional nursing care and unavoidable reoperations, and face difficulties in daily activities.…”

Section: Introductionmentioning

confidence: 99%

Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

Peng

Luo

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, reports on the reconstruction of the defects over the distal forefoot using the DPAPF flaps are scarce. Herein, we describe our experience on the reconstruction of these defects using DPAPF flaps in a considerable sample size. Methods Between February 2005 and August 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. In order to reduce the length of fascial pedicle and the total length of the DPAPF flaps, the ankles were fixed in dorsiflexion using a Kirschner wire before designing the flaps. The flaps were elevated by the anterograde–retrograde approach. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups. Results Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 ± 0.58 cm, the total length of the flap was simultaneously shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from 3.0 cm to 6.0 cm. The fascial pedicle width > 4 cm was found in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05). Conclusions The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. By fixing the ankle in dorsiflexion with Kirschner wire and widening the fascial pedicle appropriately, the top edge and LWR of the flaps will be decreased, and thus the procedures are helpful for the flaps survival.

show abstract

Traumatic Forefoot Reconstructions With Free Perforator Flaps

Cited by 10 publications

References 19 publications

Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

Reverse Peroneal Artery Flap—A Workhorse Flap for Reconstruction of Large, Distal Defects of Ankle and Foot

Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

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