ABSTRACT
BACKGROUND: Of all body regions, lower extremity wounds have been and remain the greatest challenge. Free flaps have been accepted as a reasonable option to solve this dilemma, but they require the complexity of microsurgery. This study aimed to compare the postoperative and clinical outcomes of propeller flap and fasciocutaneous free flap in the reconstruction of complex lower limb defects. MATERIALS AND METHODS: This randomized controlled trial was conducted from July 2021 to June 2023. Selected patients were randomized into two groups: the propeller flap group and fasciocutaneous free flap group. Demographic data, preoperative parameters, and postoperative parameter, including esthetic analysis, scar assessment, neurosensory analysis, psychosocial analysis, and lower extremity function, were estimated and statistically significant compared between the two study groups. RESULTS: Road traffic accident (73.3%) was the most common etiology for lower limb defects in both groups. The foot and lower third of the leg were the most common site of defect, constituting 79.99%. The duration of surgery was significantly shorter in propeller flap as compared to fasciocutaneous free flaps. Flap size was smaller, with better neurosensory improvements in propeller flap group. Esthetic analysis, scar assessment, psychosocial analysis, and lower extremity functional analysis yielded similar results in both study groups. CONCLUSION: Propeller flap has better outcomes compared to free flap in terms of smaller size of flap, shorter duration of surgery, and reduced length of hospital stay. Comparable results were obtained with respect to esthetic score, scar assessment score, psychosocial analysis, and neurosensory recovery and lower extremity functional score.
Subject(s)
Free Tissue Flaps , Plastic Surgery Procedures , Humans , Male , Female , Plastic Surgery Procedures/methods , Prospective Studies , Middle Aged , Adult , Leg Injuries/surgery , Lower Extremity/surgeryABSTRACT
Primary tuberculosis of the chest wall is a rare disease and very difficult to diagnose without clinical suspicion. Here, we present an unusual case of necrotizing fasciitis due to an aggressive form of chest wall tuberculosis. A 22-year-old male presented in emergency with acute-onset swelling and redness over the right side of the neck and chest wall. He had no history of any drug reaction, trauma, and unknown bite. The patient underwent aggressive debridement followed by split-thickness graft under intensive care monitoring. Radiological imaging and Ziehl-Neelsen (ZN) staining of pleural fluid revealed no evidence of pulmonary tuberculosis. Special investigations such as cartridge-based nucleic acid amplification test and ZN staining from pathological skin or subcutaneous tissue revealed active tuberculosis; therefore, anti-tubercular drugs were started.
