Soft-tissue management and subsequent salvage of the lower extremity following trauma has long presented difficult challenges to the plastic surgeon.Trauma to the lower extremity can produce long-term sequelae consist...Soft-tissue management and subsequent salvage of the lower extremity following trauma has long presented difficult challenges to the plastic surgeon.Trauma to the lower extremity can produce long-term sequelae consisting of psychological trauma,functional deficits,and increased costs to the healthcare system.Avoiding incorrect management is important,and is compounded by the fact that few guidelines exist on appropriate treatment and patient counseling.This study aims to describe the authors’experience at a large limb salvage center in order to further delineate management strategies.展开更多
Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fe...Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fear of historically described poor surgical outcomes.The aim of this study is to investigate more recent articles describing free-flap microsurgical reconstruction for these defects.Methods:A systematic review of the literature was conducted through the online databases PubMed,Embase,and Web of Science,examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects of the pediatric(aged 18 and younger)lower extremity following traumatic etiology since 2005.Outcomes included flap failure,return to the operating room,and functional status,where available.Results:Seven studies were deemed appropriate for inclusion,with a total of 243 flaps included.Motor vehicle and motorcycle accidents were greater than 75%of total etiology.Most defects involved the foot or ankle(65.1%).In total,perforator flaps compromised the majority of flaps(54%),with the most common being the anterolateral thigh,the scapular/parascapular,and deep inferior epigastric flaps.Less common perforators included the groin flap,tensor fascia lata,radial forearm,lateral arm,and thoracodorsal perforator flap.Muscle-based flaps were less common(46%),with the latissimus dorsi and rectus muscle flaps composing the majority.The most commonly used recipient vessel was the anterior tibialis(49.5%)and posterior tibialis vessels(45.3%).Most studies performed reconstruction within 7-10 days of presentation.There was a cumulative 6.5%flap failure rate.Conclusion:Free tissue transfer for pediatric lower extremity trauma is an important tool that likely leads to powerful outcomes.Recent trends indicate increasing usage of perforator flaps.This study shows that based on existing data,free flap utilization for pediatric patients is an adequate modality for repair,and may warrant greater consideration moving forward.展开更多
Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several tech...Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several techniques have been described in the literature for the management of these bony defects,including non-vascularized bone grafts,vascularized bone grafts and distraction osteogenesis.Herein,the authors review the role of vascularized bone grafts in the management of post-traumatic bone loss in the lower extremity.展开更多
Aim:The classical keystone-design flap,although elegantly employed for various trunk defects,has limited movement on the leg.This study aims to modify the keystone–design flaps for leg defects.Methods:A keystone-desi...Aim:The classical keystone-design flap,although elegantly employed for various trunk defects,has limited movement on the leg.This study aims to modify the keystone–design flaps for leg defects.Methods:A keystone-design flap,in which perforators are identified and dissected,is described specifically for elliptical defects overlying the tibia.Results:It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy.Conclusion:The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.展开更多
文摘Soft-tissue management and subsequent salvage of the lower extremity following trauma has long presented difficult challenges to the plastic surgeon.Trauma to the lower extremity can produce long-term sequelae consisting of psychological trauma,functional deficits,and increased costs to the healthcare system.Avoiding incorrect management is important,and is compounded by the fact that few guidelines exist on appropriate treatment and patient counseling.This study aims to describe the authors’experience at a large limb salvage center in order to further delineate management strategies.
文摘Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely described.Factors include microsurgeon inexperience,inadequate center resources,and fear of historically described poor surgical outcomes.The aim of this study is to investigate more recent articles describing free-flap microsurgical reconstruction for these defects.Methods:A systematic review of the literature was conducted through the online databases PubMed,Embase,and Web of Science,examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects of the pediatric(aged 18 and younger)lower extremity following traumatic etiology since 2005.Outcomes included flap failure,return to the operating room,and functional status,where available.Results:Seven studies were deemed appropriate for inclusion,with a total of 243 flaps included.Motor vehicle and motorcycle accidents were greater than 75%of total etiology.Most defects involved the foot or ankle(65.1%).In total,perforator flaps compromised the majority of flaps(54%),with the most common being the anterolateral thigh,the scapular/parascapular,and deep inferior epigastric flaps.Less common perforators included the groin flap,tensor fascia lata,radial forearm,lateral arm,and thoracodorsal perforator flap.Muscle-based flaps were less common(46%),with the latissimus dorsi and rectus muscle flaps composing the majority.The most commonly used recipient vessel was the anterior tibialis(49.5%)and posterior tibialis vessels(45.3%).Most studies performed reconstruction within 7-10 days of presentation.There was a cumulative 6.5%flap failure rate.Conclusion:Free tissue transfer for pediatric lower extremity trauma is an important tool that likely leads to powerful outcomes.Recent trends indicate increasing usage of perforator flaps.This study shows that based on existing data,free flap utilization for pediatric patients is an adequate modality for repair,and may warrant greater consideration moving forward.
文摘Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an open fracture and surgical debridement,or secondarily as a result of nonunion or infection.Several techniques have been described in the literature for the management of these bony defects,including non-vascularized bone grafts,vascularized bone grafts and distraction osteogenesis.Herein,the authors review the role of vascularized bone grafts in the management of post-traumatic bone loss in the lower extremity.
文摘Aim:The classical keystone-design flap,although elegantly employed for various trunk defects,has limited movement on the leg.This study aims to modify the keystone–design flaps for leg defects.Methods:A keystone-design flap,in which perforators are identified and dissected,is described specifically for elliptical defects overlying the tibia.Results:It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy.Conclusion:The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.
