Superficial Circumflex Iliac Artery Perforator Free Flap for Reconstruction of Small or Medium Sized Defect on Lower Extremities

PURPOSE: For reconstruction of lower extremity defects, various flaps can be used and the appropriate flap must be selected and applied according to the size of the defect. In particular, in cases where the defect size is small to moderate, thinner or smaller volume flaps are useful. The authors performed reconstruction of small to moderate defects on the lower extremities using superficial circumflex iliac artery perforator free flaps and are reporting the results. MATERIALS AND METHODS: Fifteen patients underwent reconstruction of defects on lower extremity areas using superficial circumflex iliac artery perforator free flaps from July 2011 to July 2012 at this hospital. The flaps were elevated from above the deep fat layer, and, in all cases, the vessel diameter of the flaps was less than 1mm, with the exception of superficial vein that accompanied it. RESULTS: The mean follow up period was 4.46 months, and, despite a partial loss in the flap in two cases, there were no total losses. All donor sites were closed with primary closure, and there was no occurrence of complications, such as hematomas, seromas, or lymphorrheas. The patients were highly satisfied with the donor site scar since it could be masked by underwear. CONCLUSION: Compared to other flaps, superficial circumflex iliac artery perforator free flaps are thinner in thickness and smaller in volume, which results in a more natural contour of the recipient site after the operation. In addition, since the flap can be elevated from supra-deep fat layer, the operation time can be shortened, and lymphorrhea can be prevented, which in turn lessens donor-site morbidity.

Perforator-Based Propeller Flap for Lower Extremity Reconstruction

PURPOSE: To report the clinical results of the perforated-based propeller flap for lower extremity soft tissue reconstruction. MATERIALS AND METHODS: Between January 2010 and June 2012, a total of 16 defects in the lower extremities were covered with perforator-based propeller flaps. Retrospective data for location and size of the defect, flap dimension, pedicle artery, pedicle rotation, complications were obtained. RESULTS: Peroneal artery-based perforator flap were used in eleven cases, posterior tibial artery-based perforator flap in two cases, anterior tibial artery-based perforator flap in one case and medial plantar artery-based perforator flap in two cases. The average size of the flaps was 63 cm2. The marginal skin necrosis of the flaps as a complication was developed in two cases, one of which was covered with split-thickness skin graft. There were no functional deficits from the donor site. CONCLUSION: For the reconstruction of lower extremities, the perforator-based propeller flap could be a reasonable alternative as it is a simple, safe and versatile technique.

Measurement of the Weight-bearing Standing Coronal and Sagittal Axial Alignment of Lower Extremity in Young Korean Adults / 대한정형외과학회잡지

PURPOSE: The aim of this study was to establish a measurement standard for the weight-bearing axial alignment of the lower extremities when performing a lower extremity reconstruction. MATERIALS AND METHODS: Among 274 patients (147 males and 127 females) in their 20s to 30s without any physical disabilities, and who had undergone weight-bearing full leg standing radiographs, 188 patients (100 males and 88 females) were examined this study. The data was analyzed further according to their age and gender using the radiographic value on the coronal and sagittal alignment of the lower extremities. RESULTS: The weight bearing ratio was 38.47+/-10.52% on the coronal plane and 36.11+/-7.88% on the sagittal plane. Both the mechanical axis and the the weight bearing axis were not identical due to their 0.68+/-0.89degrees difference on average. The most adjacent point of the femoral condyles to the tibial plateau on the sagittal plane was assigned to the center of the knee joint. The difference between the mechanical axis and weight bearing axis was 0.04degrees, which was not significant. CONCLUSION: There is a difference between the mechanical axis, which consists of both a line from the center of the femoral head to the center of knee joint and a line from the center of the knee joint to the center of ankle joint, and the weight bearing axis, which is linked directly from the center of the femoral head to the center of the ankle joint. Furthermore, the weight bearing axis passes through the anteromedial part in the knee joint. The center of the knee joint is defined as the most adjacent point of both femoral condyle to the tibial plateau on the sagittal plane.

Lower Extremity Reconstruction by Perforator Based Flap

PURPOSE: Fasciocutaneous flap with random pattern flap has limitation in mobility and length-width ratio. This characteristic is more pronounced in lower extremity which has relatively poor vascularity. Perforator based flap in lower extremity reconstruction has various advantages as an axial flap, allowing abundant blood supply and widening of mobility range. So if it is not a case of wide defect, free flap can be replaced by perforator based flap. METHODS: From April 2007 to March 2009, 18 cases of perforator flap were performed. 8 had defect in upper 1/3 of calf, 6 in middle 1/3, and 4 in lower 1/3. Among 10 cases in which island flap were used, 3 cases had transposition flap, 2 cases used advancement flap, 2 cases had propeller flap, and 1 case had rotation flap. RESULTS: 17 cases survived without flap necrosis. Partial flap necrosis occurred in 1 case, so secondary split thickness skin graft was done. Chronic wound with pseudomonas infection occurred in 1 case, but it was completely cured with conservative treatment. CONCLUSION: Perforator based flap is useful in lower extremity reconstruction because of relative freedom in changing the size and thickness of the flap depending on the recipient site, good mobility, and abundant vascularity. And donor site morbidity can be minimized. Lower extremity reconstruction using perforator based flap is a good method because it can minimize the complication and obtain effective result.

The Value of Local Flaps in Lower Extrimity Reconstruction

PURPOSE: The aim of this study was to evaluate the outcome and the effectiveness of local flaps in lower extremity reconstruction. MATERIALS AND METHODS: We have performed lower extremity reconstruction with local flap in 14 cases (10 males and 4 females) from May 2006 to February 2008. The mean age was 40.1 years (range, 16~67). The defect site was the tibia in 5 cases, the ankle in 1 case and the foot in 8 cases. The local flaps were reverse flow sural artery flap in 7 cases, gastrocnemius flap in 3 cases, lateral supramalleolar flap in 2 cases, dorsalis pedis flap in 1 case and medial hemisoleus flap in 1 case. RESULTS: All flaps were survived. Venous congestion was developed in 1 case of the rerverse flow sural artery flap but healed with secondary rotational flap. Other flaps were good without any complications. CONCLUSION: If we choose precisely indicated local flap in lower extremity reconstruction, the resultant coverage of defect would be excellent.

Reconstruction of Soft - Tissue Defects in the Lower Extremities Using Local or Free Muscle Flaps

According to increment of industrial accidents and traffic accidents, complex injuries of the lower extremity accompanied with broad soft-tissue defects. Lower extremity possess disadvantageous anatomical characteristics includes poor vascularity easily result in compromised circulation, rigid tissue distensibility, easy infectability followed by soft-tissue defects and relatively long healing periods. Furthermore, it easily happens that osteomyelitis or non-union was followed by bony exposure or fractures, and it must considered to weight-bearing or gate. So, It is impotant to select a appropriate method in reconstruction of the lower extremities and it is applicable to variety of surgical techniques according these considerations. The goal of flap coverage in the lower extremity should be not only satisfactory wound coverage, but also acceptable appearance and minimal donor site morbidity. The Authors estimated that skin graft and local flap surgery for bony exposed area and soft-tissue defect in weight- bearing area may not be successful. In this article, we have tried to established a reconstruction method in the lower extremity based on experiences and clinical analyses of reconstruction of the soft-tissue defects using local or free muscle flap transfer in 54 cases(49 patients) from 1993.3 to 2000.2. Results revealed 93% flap survival, but there were flap failure noted in 4 cases: one appears in the local muscle flap transfer, other three appear in the free muscle flap transfer. Among the 49 patents, 28 patients(58%) accompanied with open comminuted fractures and 11 patients (22%) visited us with infection. We think that soft-tissue defects in lower extremities associated with open comminuted fractures and infections should be reconstructed by flaps that include healthy muscles effectively due to benefits of muscle itself.