Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried o...Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.展开更多
Background:Following combat-related,extensive soft tissue injury from gunshot wounds or blasts,prolonged duration from injury to full wound closure is associated with infection,increased morbidity and mortality,failur...Background:Following combat-related,extensive soft tissue injury from gunshot wounds or blasts,prolonged duration from injury to full wound closure is associated with infection,increased morbidity and mortality,failure to mobilize,poor functional outcome and increased cost.The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds.Methods:This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries(5 gunshot wounds,5 blasts)treated using the TopClosure^(■)Tension Relief System(TRS)with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy(ROINPT)via the Vcareα^(■)device.Results:Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction.Two patients had upper limb injury and the rest lower limb injury.With the aid of the TRS and/or ROINPT,immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three.Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure.Wound closure was achieved within 0–37 days(median:12.5 days,interquartile range:2.75–19.75)from injury.Conclusions:The TRS is a novel device for effective,early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep,achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders.Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy,mitigating anaerobic contamination and reducing infection.Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration.The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.展开更多
文摘Summary： In this study we present our experiences with the reverse sural fasciocutaneous flap to reconstruct the distal lower limb soft tissue defects caused by traumatic injuries. These flap graftings were carried out from Oct. 2010 to Dec. 2012 in our department. The series consisted of 36 patients, including 21 men and 15 women with an average age of 46.2 years （14-83 years） and with a medium followp period of 18 months （12-24 months）. Of all the cases of acute trauma, there were 10 eases of trauma of distal tibia, 9 cases of trauma of perimalleolus, and 17 cases of trauma of midfoot and forefoot. Related risk factors in the patients were diabetes （2 cases）, advanced age （〉65 years, 3 cases） and ciga- rette smoking （6 cases）. The reverse flow sural island flap irrigation depended on lower perforators of the peroneal artery. The fasciocutaneous pedicle was 3-4 cm in width and the anatomical structures consisted of the superficial and deep fascia, the sural nerve, short saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin. The most proximal border of the flap was only 1.5 cm away from the popliteal skin crease and the pivot point was 5-7 cm above the tip of the lateral malleolus. All the flaps survived. No arterial crisis occurred in any case. The venous congestion occurred in 2 cases and got better after raising the limbs and bloodletting. Only in an old man, 1.5 cm necrosis of distal margin of his flap occurred and finally healed after continuous dressing change. One-stage skin grafting was performed, and all the donor sites were sutured and successfully healed. It was concluded that the reverse sural fasciocutaneous flap is safe and reliable to extend to the proximal third even near the popliteal skin crease. We also concluded this flap can be safely and efficiently used to treat patients with large and far soft-tissue defects from the distal leg to the forefoot with more versatility and it is easier to reach the recipient sites.
文摘Background:Following combat-related,extensive soft tissue injury from gunshot wounds or blasts,prolonged duration from injury to full wound closure is associated with infection,increased morbidity and mortality,failure to mobilize,poor functional outcome and increased cost.The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds.Methods:This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries(5 gunshot wounds,5 blasts)treated using the TopClosure^(■)Tension Relief System(TRS)with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy(ROINPT)via the Vcareα^(■)device.Results:Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction.Two patients had upper limb injury and the rest lower limb injury.With the aid of the TRS and/or ROINPT,immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three.Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure.Wound closure was achieved within 0–37 days(median:12.5 days,interquartile range:2.75–19.75)from injury.Conclusions:The TRS is a novel device for effective,early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep,achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders.Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy,mitigating anaerobic contamination and reducing infection.Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration.The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.
