Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Aim:The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps,by including hyperbaric oxygen(HBO)therapy in the treatment regimen with flap delay.Methods:We present a prospective study of 23 patients with various types of soft tissue defects of the foot,and lower third of leg managed in our institution from December 2012 to December 2013.All soft tissue defects were treated by a reverse pedicle flap.Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy.The postoperative period,hospital course,and follow-up were documented.Results:Of 12 patients with flap delay and HBO,10 patients did not suffer any complications secondary to flap transfer.One patient had discoloration of the tip of the flap,which settled without the intervention,and 1 patient had recurrent abscess formation,which required debridement and closure.Of 11 patients with direct transfer,6 patients presented with complications including flap congestion,partial flap loss,and tip necrosis,which required secondary intervention.Conclusion:HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.