Aim:To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.Methods:A PubMed literature search yielded 14 articles included for systematic review.Data were extracted from each articl...Aim:To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.Methods:A PubMed literature search yielded 14 articles included for systematic review.Data were extracted from each article if available(sample size,patient age,surgical indications,type of flap,use of additional modalities,method of bone osteogenesis,postoperative events,follow-up,satisfaction,weight-bearing status,and success rate).Unpaired t-tests were performed to compare complication rates.A retrospective review of three cases was also conducted.Results:Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average.Indications included chronic osteomyelitis or nonunion(58.2%)and acute trauma(41.8%).Average time from injury was 1.1 years.Ilizarov frame was used in 12 articles.Free flaps(88.0%)or rotational flaps(12.0%)were used,with muscle flaps(96.7%)being most common.Most extremities received free latissimus dorsi or rectus abdominis flaps.Bone grafts and antibiotic beads were often used in conjunction.Although complications and reoperations were not uncommon(up to 30%),98.8%of patients on average were ultimately weight bearing and all articles reported>91%success rate.Additionally,the rates of any complication were not statistically different between"fix and flap"protocol and flap or frame first.Lastly,a three-patient case series is presented.Conclusion:Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting.Not one surgical approach to limb salvage is superior,and decision should be made on a case by case basis between the surgeon and the patient.展开更多
Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applie...Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue展开更多
Long-standing wounds are at high risk for infection.Therefore,it is critical to achieve wound healing in a timely manner;however,some complex wounds remain recalcitrant and difficult to treat.Local muscle flaps are an...Long-standing wounds are at high risk for infection.Therefore,it is critical to achieve wound healing in a timely manner;however,some complex wounds remain recalcitrant and difficult to treat.Local muscle flaps are an underutilized technique with great utility in the reconstruction of complex foot wounds.Providing a healthy bleeding base that promotes wound healing,these muscle flaps can greatly benefit the patient and prevent amputation.In this present report,we demonstrate the use of the abductor hallucis muscle flap in the reconstruction of a complex wound following bunion surgery.展开更多
Lower extremity reconstruction is challenging for a variety of reasons.New techniques for soft tissue coverage continue to evolve.While free flaps are always an option,free flaps require significant microsurgical expe...Lower extremity reconstruction is challenging for a variety of reasons.New techniques for soft tissue coverage continue to evolve.While free flaps are always an option,free flaps require significant microsurgical expertise,a proficient staff,advanced equipment,and a patient with a somewhat healthy baseline.However,as microsurgery has evolved,so has the identification of new anatomy and new techniques-namely,perforator based pedicled flaps.These flaps have expanded options for lower extremity reconstruction,and continue to advance the field of microsurgery.The purpose of this article is to review the evolution of perforator based pedicled flaps in the lower extremity,review the anatomy,and offer examples of design and indications.展开更多
文摘Aim:To review the choices of soft tissue coverage in distraction osteogenesis of the extremity.Methods:A PubMed literature search yielded 14 articles included for systematic review.Data were extracted from each article if available(sample size,patient age,surgical indications,type of flap,use of additional modalities,method of bone osteogenesis,postoperative events,follow-up,satisfaction,weight-bearing status,and success rate).Unpaired t-tests were performed to compare complication rates.A retrospective review of three cases was also conducted.Results:Fourteen articles discussed 145 patients with a mean age of 33.4 years and 146 extremity injuries followed over 3.3 years on average.Indications included chronic osteomyelitis or nonunion(58.2%)and acute trauma(41.8%).Average time from injury was 1.1 years.Ilizarov frame was used in 12 articles.Free flaps(88.0%)or rotational flaps(12.0%)were used,with muscle flaps(96.7%)being most common.Most extremities received free latissimus dorsi or rectus abdominis flaps.Bone grafts and antibiotic beads were often used in conjunction.Although complications and reoperations were not uncommon(up to 30%),98.8%of patients on average were ultimately weight bearing and all articles reported>91%success rate.Additionally,the rates of any complication were not statistically different between"fix and flap"protocol and flap or frame first.Lastly,a three-patient case series is presented.Conclusion:Bone transport with soft tissue reconstruction remains an excellent choice for patients with large bony defects or who are unable to undergo autologous bone grafting.Not one surgical approach to limb salvage is superior,and decision should be made on a case by case basis between the surgeon and the patient.
文摘Objective To investigate a simple, valuable new method for coverage of the soft tissue defect over the lower one-third of the leg, ankle and the foot. Methods The distally based peroneus brevis muscle fkps were applied for coverage of the soft tissue defects over the lower one-third of the leg,the ankle and the foot. The muscle flaps were covered with split-thickness skin grafts. Results The distally based peroneus brevis muscle flaps were applied for coverage of the soft tissue defects over the lower one-third of the leg, the ankle and the foot in 16 cases. The larges area of the soft tissue defect was 5 cm × 7 cm. The smallest was 3 cm × 4 cm. Primary healing occured in 14 cases undergoing muscle flap construction, second-stage healing occured in 2 cases, no total flap necrosis occured in any cases. Conclusion ThisChina Medical Abstracts(Surgery) technigue is a simple and complication are lesser. The successful rates are higher. This muscle flap is suitable to the mudium or small soft tissue
文摘Long-standing wounds are at high risk for infection.Therefore,it is critical to achieve wound healing in a timely manner;however,some complex wounds remain recalcitrant and difficult to treat.Local muscle flaps are an underutilized technique with great utility in the reconstruction of complex foot wounds.Providing a healthy bleeding base that promotes wound healing,these muscle flaps can greatly benefit the patient and prevent amputation.In this present report,we demonstrate the use of the abductor hallucis muscle flap in the reconstruction of a complex wound following bunion surgery.
文摘Lower extremity reconstruction is challenging for a variety of reasons.New techniques for soft tissue coverage continue to evolve.While free flaps are always an option,free flaps require significant microsurgical expertise,a proficient staff,advanced equipment,and a patient with a somewhat healthy baseline.However,as microsurgery has evolved,so has the identification of new anatomy and new techniques-namely,perforator based pedicled flaps.These flaps have expanded options for lower extremity reconstruction,and continue to advance the field of microsurgery.The purpose of this article is to review the evolution of perforator based pedicled flaps in the lower extremity,review the anatomy,and offer examples of design and indications.
