A Retrospective Review of Outcomes and Flap Selection in Free Tissue Transfers for Complex Lower Extremity Reconstruction

Assessment of sural flap microcirculation: Which position maintains the optimal perfusion?

BACKGROUND

Limb elevation is a commonly used approach for reducing edema and increasing venous drainage. Considering the anatomy of the sural flap with retrograde perfusion and hence potentially difficult blood outflow, the best angle for positioning the leg following operation is not yet known.

METHODS

A total of 14 patients undergoing sural flap lower limb reconstruction were enrolled in the study. We assessed the perfusion dynamics of the flaps using the oxygen-to-see (O2C) device that combines laser light, to determine blood flow, and white light to determine the relative amount of hemoglobin and oxygen saturation. Three different positions were evaluated: 45° angle downward, the horizontal position, and 45° angle upward.

RESULTS

The blood flow was significantly higher in the 45° upward position compared to the 45° downward position. The relative amount of hemoglobin was significantly lower in the 45° upward position compared to the 45° downward position. No significant differences with regard to oxygen saturation were observed.

CONCLUSION

The results of this study show a more precise pattern of perfusion due to different positioning. The 45° upward position of the leg generally maintains the best blood flow and venous drainage. However, compared to horizontal positioning, these differences were not statistically significant. As an elevation of 45° can be uncomfortable for patients, we recommend an elevation of the leg which approximates the 45° upward position but is still comfortable.

Lower Extremity Limb Salvage After Trauma: Versatility of the Anterolateral Thigh Free Flap

OBJECTIVES

To compare the outcomes and complications of the anterolateral thigh free flap (ALT FF) versus other free muscle flaps for reconstruction of traumatic defects of the lower extremity.

DESIGN

Retrospective review from a single plastic and reconstructive surgical unit comparing outcomes between 2 free flap groups-ALT FF and other commonly used muscle free flaps.

SETTING

Tertiary referral University Hospital Level I Trauma Center.

PATIENTS

Hundred patients who underwent lower extremity salvage for traumatic injuries.

INTERVENTION

Free flap coverage of traumatic lower extremity injuries.

MAIN OUTCOMES MEASUREMENTS

Successful for limb salvage, intraoperative and postoperative complications.

DATA SYNTHESIS

Categorical variables were analyzed using χ and Fisher exact tests; continuous variables were examined using Wilcoxon rank-sum test.

CONCLUSIONS

The ALT FF is equivalent in success to other traditional nonfasciocutaneous free flaps but may provide a more durable supple coverage with all components of the native soft-tissue envelop that can be tailored to the reconstructive needs of the traumatized lower extremity. Limb salvage outcomes may still be heavily influenced by the original severity of injury.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.