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Chellamuthu A, Jayaraman SK, A. RB. Outcome Analysis Comparing Muscle and Fasciocutaneous Free Flaps for Heel Reconstruction: Meta-Analysis and Case Series. Indian J Plast Surg 2023; 56:13-21. [PMID: 36998938 PMCID: PMC10049829 DOI: 10.1055/s-0042-1760093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background Choosing the components of free flap (fasciocutaneous or muscle) is one of the crucial but controversial decisions in heel reconstruction. This meta-analysis aims to provide an up-to-date comparison of fasciocutaneous flaps (FCFs) and muscle flaps (MFs) for heel reconstruction and to ascertain if one flap has an advantage over the other.
Methods Following the Preferred Reporting Item for Systematic Reviews and Meta-Analyses guidelines, a systematic literature review was performed identifying studies on heel reconstruction with FCF and MF. Primary outcomes were survival, time of ambulation, sensation, ulceration, gait, need for specialized footwear, revision procedures, and shear. Meta-analyses and Trial Sequential Analysis (TSA) were performed to estimate the pooled risk ratios (RRs) and standardized mean difference (SMD) with fixed effects and random effects models, respectively.
Results Of 757 publications identified, 20 were reviewed including 255 patients with 263 free flaps. The meta-analysis showed no statistically significant difference between MF and FCF in terms of survival (RR, 1; 95% confidence interval [CI], 0.83, 1.21), gait abnormality (RR, 0.55; 95% CI, 0.19, 1.59), ulcerations (RR, 0.65; 95% CI, 0.27, 1.54), footwear modification (RR, 0.52; 95% CI, 0.26, 1.09), and revision procedures (RR, 1.67; 95% CI, 0.84, 3.32). FCF had superior perception of deep pressure (RR, 1.99; 95% CI, 1.32, 3.00), light touch, and pain (RR, 5.17; 95% CI, 2.02, 13.22) compared with MF. Time to full weight-bearing (SMD, –3.03; 95% CI, –4.25, –1.80) was longer for MF compared with FCF. TSA showed inconclusive results for comparison of the survival of flaps, gait assessment, and rates of ulceration.
Conclusion Patients reconstructed with FCF had superior sensory recovery and early weight bearing on their reconstructed heels, hence faster return to daily activities compared with MFs. In terms of other outcomes such as footwear modification and revision procedure, both flaps had no statistically significant difference. The results were inconclusive regarding the survival of flaps, gait assessment, and rates of ulceration. Future studies are required to investigate the role of shear on the stability of the reconstructed heels.
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Affiliation(s)
- Abiramie Chellamuthu
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Sathish Kumar Jayaraman
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Ramesh B. A.
- Department of Plastic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Maurya S, Srinath N, Bhandari PS. Negative pressure wound therapy in the management of mine blast injuries of lower limbs: Lessons learnt at a tertiary care center. Med J Armed Forces India 2018; 73:321-327. [PMID: 29386704 DOI: 10.1016/j.mjafi.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022] Open
Abstract
Background Mine blast injuries of foot are devastating injuries that result in composite tissue loss or amputations. Negative pressure wound therapy has helped in the management of such combat-related wounds. The aim of this study was to report experiences gained in managing such injuries at a tertiary care center. Methods 17 combatants who sustained mine blast injuries were included in this study. Severity of foot injury was assessed as per Foot and Ankle Severity Score. After wound debridement, negative pressure wound therapy was started and foot defect was appropriately reconstructed. Following wound healing, the foot was assessed for Foot and Ankle Severity Score in terms of impairment. The patients were then suitably rehabilitated by shoe modifications, orthosis, or custom-made prosthesis. Results Mean age of soldiers who sustained mine blast injuries was 30.2 years. The mean Foot and Ankle Severity Score was 3.76. Temporary wound closure was achieved using negative pressure wound therapy and it prevented local and systemic infection. The defect could be reconstructed appropriately using split skin graft, regional fasciocutaneous flap, or microvascular free flap. Mean time to definitive reconstructive procedure was 16.5 days. Mean Foot and Ankle Severity Score in terms of impairment was 4.11. All soldiers could be rehabilitated and were returned to their respective units and were able to perform sedentary duties assigned to them. Conclusion The negative pressure wound therapy was helpful in preventing proximal amputations due to mine blast injury and was helpful in satisfactory reconstruction of foot defects.
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Affiliation(s)
- Sanjay Maurya
- Senior Advisor (Surgery) & Reconstructive Surgeon, Command Hospital (Southern Command), Pune 411040, India
| | - N Srinath
- Senior Consultant (Surgery), O/o DGAFMS, New Delhi 11000, India
| | - P S Bhandari
- Consultant (Plastic Surgeon), Brij Lal Hospital, Haldwani, Uttrakhand, India
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Sahin I, Nisanci M, Aykan A, Guzey S, Ozturk S, Isik S. Reconstruction of the one-digit foot with an osteocutaneous fibula flap: a case report. J Am Podiatr Med Assoc 2016; 104:526-30. [PMID: 25275744 DOI: 10.7547/0003-0538-104.5.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The decision to amputate or reconstruct after high-energy foot injuries is controversial. A 25-year-old male patient was admitted to our clinic with a complex injury to his left foot sustained during a mine explosion, and the second to fifth digits and metatarsals of the left foot had been traumatically amputated before admission to our facility. The complex left foot defect was reconstructed with an osteocutaneous fibula flap during a single session. An osteotomy was performed on the bone segment of the flap, and both lateral longitudinal and transverse arches were repaired. Both aesthetic and functional outcomes were very satisfactory, including independent ambulation, light jogging, and full performance of activities of daily living without limitation. Many factors, including comorbidities, should be considered during the decision-making process of amputating or reconstructing complex foot injuries.
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Affiliation(s)
- Ismail Sahin
- Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Mustafa Nisanci
- Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Andac Aykan
- Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Serbulent Guzey
- Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Serdar Ozturk
- Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey
| | - Selcuk Isik
- Department of Plastic Reconstructive and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey
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Tekin L, Zor F, Akarsu S, Tuncer SK, Oztürk S, Oztürk S. Quality of life and functionality of patients with heel reconstruction after landmine explosions. PM R 2013; 5:591-5. [PMID: 23399298 DOI: 10.1016/j.pmrj.2013.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 01/14/2013] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Landmine injuries cause extensive soft and bony tissue loss of the weight-bearing areas, particularly the heel. Reconstruction of these injuries is challenging, and there are no studies that report long-term functional results. OBJECTIVE To determine the quality of life and long-term functionality of patients who had heel reconstruction with free muscle flap after landmine injuries. DESIGN A case-control study. PARTICIPANTS Nine male patients who had heel reconstruction with free muscle flap. Ten male volunteers without any gait disorder were included in the study as the control group. METHODS AND INTERVENTIONS Functional ambulation scale, visual analog scale, energy expenditure index, 6-minute walking test, 10-m walking test, and Short Form 36 were performed to determine the quality of life and functionality of the participants. RESULTS There were no statistically significant differences between the 2 groups in terms of functional ambulation scale, energy expenditure index, 6-minute walking test, and 10-m walking test. Regarding Short Form 36 scores, all subgroup values were lower in the reconstruction group, whereas only those of general health, vitality, and physical-emotional role limitation subgroups showed statistical significance. Mean visual analog scale scores were found to be statistically different between the groups (P < .05). Mean Freiburg Ankle scores showed moderate functionality. CONCLUSION Despite the associated physical and emotional trauma, combat-injured veterans with heel reconstruction after landmine injuries had adequate and functional ambulation at long-term follow-up. Early rehabilitation and close cooperation between surgeons and rehabilitation physicians during the care of these patients will enhance patient outcomes.
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Affiliation(s)
- Levent Tekin
- Department of Physical Medicine and Rehabilitation, Haydarpaşa Training Hospital, Gülhane Military Medical Academy, Istanbul, Turkey.
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Lykoudis EG, Gantsos A, Dimou AO. Complex calcaneal defect reconstruction with osteotomized free fibula-flexor hallucis longus osteomuscular flap. Microsurgery 2013; 33:63-8. [DOI: 10.1002/micr.22053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/22/2012] [Accepted: 08/29/2012] [Indexed: 11/10/2022]
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Quality of Life and Functionality of Patients with Heel Reconstruction after Landmine Explosions. Plast Reconstr Surg 2012. [DOI: 10.1097/01.prs.0000421764.38018.ce] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oh SJ, Moon M, Cha J, Koh SH, Chung CH. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg 2011; 64:248-54. [DOI: 10.1016/j.bjps.2010.04.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/31/2010] [Accepted: 04/11/2010] [Indexed: 11/24/2022]
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Alagoz MS, Orbay H, Uysal AC, Comert A, Tuccar E. Vascular anatomy of the metatarsal bones and the interosseous muscles of the foot. J Plast Reconstr Aesthet Surg 2009; 62:1227-32. [DOI: 10.1016/j.bjps.2007.12.083] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2007] [Revised: 12/24/2007] [Accepted: 12/29/2007] [Indexed: 11/26/2022]
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9
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Lykoudis EG, Dimitrios P, Alexandros BE. One-stage reconstruction of the complex midfoot defect with a multiple osteotomized free fibular osteocutaneous flap: Case report and literature review. Microsurgery 2009; 30:64-9. [DOI: 10.1002/micr.20687] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
We report a case in which Ilizarov distraction osteogenesis was used to lengthen the portion of calcaneum that remained after a radical debridement for osteomyelitis. The patient was able to walk normally in unmodified shoes at the end of his treatment.
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Affiliation(s)
- M. R. Brinker
- Center for Problem Fractures and Limb Restoration Fondren Orthopedic Group, 7401 S. Main Street, Houston, Texas 77030, USA
| | - D. P. Loncarich
- Center for Problem Fractures and Limb Restoration Fondren Orthopedic Group, 7401 S. Main Street, Houston, Texas 77030, USA
| | - E. G. Melissinos
- University of Texas Medical School-Houston, 6410 Fannin St Ste 1220, Houston, Texas 77030, USA
| | - D. P. O’Connor
- University of Houston, 3855 Holman GAR 104, Houston, Texas 77204-6015, USA
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Keklikçi K, Uygur F, Cengiz Bayram F, Cilli F. Free-fillet flap harvested in 'severe, high-energy landmine explosion' injuries of lower extremity: a case report. J Plast Reconstr Aesthet Surg 2009; 63:e58-61. [PMID: 19345166 DOI: 10.1016/j.bjps.2009.02.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 02/07/2009] [Indexed: 11/18/2022]
Abstract
Fillet flaps harvested from the non-replantable or unsalvageable amputated segment can be used to cover tissue defects. We discuss the case of a patient who had suffered a severe high-energy landmine injury, including severe leg damage, resulting in a below-knee amputation and soft-tissue defect around the forearm region. We successfully harvested the fillet from the amputated part of the extremity to the forearm region. We conclude that harvesting of a fillet flap from severely injured lower extremity, resulting from a high-energy landmine explosion, is technically feasible.
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Affiliation(s)
- Kenan Keklikçi
- Department of Orthopedic and Traumatology, Gülhane Military Medical Academy and Medical Faculty, Haydarpaşa Training Hospital, Istanbul, Turkey
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12
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Affiliation(s)
- J Clasper
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham.
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13
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Chai Y, Zeng B, Cai P, Kang Q, Chen Y, Wang C. A reversed superficial peroneal neurocutaneous island flap based on the descending branch of the distal peroneal perforator: Clinical experiences and modifications. Microsurgery 2007; 28:4-9. [PMID: 18085706 DOI: 10.1002/micr.20437] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yimin Chai
- Department of Orthopedic Surgery, The Sixth People's Hospital, Jiao Tong University, Shanghai, China
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14
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Scheufler O, Kalbermatten D, Pierer G. Instep free flap for plantar soft tissue reconstruction: Indications and options. Microsurgery 2007; 27:174-80. [PMID: 17326193 DOI: 10.1002/micr.20327] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pedicled instep flaps are frequently used in weight-bearing plantar reconstruction, but may not be available after severe foot injuries. Although free instep flaps offer a viable option, they have scarcely been reported. A posttraumatic plantar forefoot defect was reconstructed with a sensate, instep free flap, because local flaps were not available and defect size did not require a distant free flap, and the current literature was reviewed for therapeutic options. The instep free flap yielded an excellent functional and aesthetic long-term result. In the literature, pedicled instep flaps are advocated for moderate size defects of the weight-bearing heel and sole, while free flaps from distant sites are preferred for large defects. Although skin-grafted muscle flaps and fasciocutaneous flaps yield similar results, reconstruction by like tissues appears favorable. We suggest the instep free flap for weight-bearing plantar foot reconstruction, when pedicled instep flaps are not available and distant free flaps are avoidable.
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Affiliation(s)
- Oliver Scheufler
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basil, Switzerland.
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15
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Sanal HT, Bulakbasi N, Kocaoglu M, Yildirim D. MRI in long-term evaluation of reconstructed hind-feet of land-mine trauma patients. Eur J Radiol 2006; 63:270-3. [PMID: 17182210 DOI: 10.1016/j.ejrad.2006.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 10/16/2006] [Accepted: 11/10/2006] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The purpose of this study was to assess the flap reconstructed hind feet of patients with MRI who were traumatized by land-mine. MATERIALS AND METHODS T1 and T2 weighted images were obtained in 7 patients, 12 months later the reconstruction of their hind feet by myocutaneous flaps after land-mine trauma. RESULTS In all patients T2 signal intensities of the myocutaneous flaps were slightly high compared to normal undisturbed muscle. Slight vascular engorgement was noted in the vicinity of the flaps in all cases. There were ankle joint ankylose (n=1), tarsal coalition (n=3), sklerosis within the calcaneus (n=1), bone cortex irregularities (n=3), absence of calcaneus (n=4), deformity in talus and bone marrow edema (n=1), navicular edema (n=2), remodeling in the superior aspect of talus neck (n=2), absence of talus (n=2), talocalcaneal ankylose (n=1), small collection in the superior aspect of flap (n=1), drenage canules (n=1). CONCLUSION In reconstructed hind feet by myocutaneus flaps done for land-mine traumas, MRI presents useful information by displaying detailed anatomy of the flaps, bones, joints, soft tissues and associated complications.
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Affiliation(s)
- Hatice Tuba Sanal
- Department of Radiology, Gulhane Military Medical Academy, Ankara, Turkey.
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16
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Oztürk S, Bayram Y, Möhür H, Deveci M, Sengezer M. Evaluation of Late Functional Results of Patients Treated with Free Muscle Flaps for Heel Defects Caused by Land-Mine Explosions. Plast Reconstr Surg 2005; 116:1926-36. [PMID: 16327605 DOI: 10.1097/01.prs.0000189202.50629.a3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-energy land-mine explosions cause extensive soft-tissue and bone defects in the heel area, which mostly require free flap coverage. In this article, the authors present the long-term functional outcomes of 72 patients who had free muscle flap reconstructions for composite heel defects caused by land-mine explosions. METHODS The composite heel defects of 72 male patients caused by land-mine explosions were reconstructed by means of free muscle flaps. The mean follow-up was 6.5 years (range, 1 to 12 years). Each patient completed a questionnaire rating his level of satisfaction. Dynamic foot pressure distribution testing, three-dimensional motion analysis, and dynamic electromyography were performed for all patients. The data were compared with the control group of 20 volunteers. Statistical analysis was performed by Kruskal-Wallis, Mann-Whitney U, and Wilcoxon tests. RESULTS Dynamic pressure distribution tests revealed significantly higher pressure and load in the injured feet of the patients (p < 0.05). Three-dimensional motion analysis showed restricted range of motion at the ankle joints of the injured extremity (p < 0.05). Seventeen patients were able to stand as long as the control group; the mean standing time for the others was 2.85 hours per day (range, 36 minutes to 5.32 hours). Many of the patients (71 percent) declared their satisfaction of having their own feet instead of prostheses. CONCLUSIONS This is the longest series documenting the long-term functional results of patients injured by land mines who were treated with free muscle flaps. Reconstructive options should be preferred to amputation procedures in extensive tissue loss caused by land-mine explosion where possible.
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Affiliation(s)
- Serdar Oztürk
- Department of Plastic and Reconstructive Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
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Harjai MM, Agarwal DC, Dave P, Jog SS, Arora P. Mine Blast Injuries - Our Experience. Med J Armed Forces India 2005; 61:143-7. [PMID: 27407736 DOI: 10.1016/s0377-1237(05)80010-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Accepted: 07/02/2004] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The sudden increase in incidence and magnitude of mine blast injuries prompted us to highlight the problem and its management. METHODS The cases of mine blast injuries occurring during mining and demining in a particular geographical area were analysed. Total 27 cases of mine blast injuries occurred during mining or demining operations in a period of 13 months. RESULTS Various body regions were involved in the mine blast injuries but the main brunt was borne by feet and legs followed by multiple body regions due to splinters. 14 patients underwent below knee (BK) amputation while 4 patients required through knee (TK) amputations. The effect of blast was so severe that most of the cases required 2 to 5 times wound debridements. The initial aggressive debridement / open stump amputation saved the limb and life of all patients. CONCLUSION A mine blast causes extensive injuries and psychological trauma. Management is needed urgently, surgery is difficult, and amputation is often inevitable. Maximum lives and limbs can be saved with aggressive debridement, repeated inspections and dressings under anaesthesia and definitive closure at optimum time.
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Affiliation(s)
- M M Harjai
- Classified Specialist (Surgery & Paediatric Surgery), Army Hospital (R & R), Delhi Cantt - 10
| | - D C Agarwal
- Senior Adviser (Surgery & Orthopaedics), Base Hospital, Lucknow
| | - P Dave
- Classified Specialist (Surgery), 166 Military Hospital, C/o 56 APO
| | - S S Jog
- ADMS, HQ Central Command (Medical), Lucknow-2
| | - P Arora
- Commandant, Armed Forces Medical College, Pune-40
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Celiköz B, Sengezer M, Işik S, Türegün M, Deveci M, Duman H, Acikel C, Nişanci M, Oztürk S. Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines. Microsurgery 2005; 25:3-14; discussion 15. [PMID: 15643656 DOI: 10.1002/micr.20049] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The present study reviews 215 male patients suffering high velocity-high energy injuries of the lower leg or foot caused by war weapons such as missiles, gunshots, and land mines. They were treated in the Department of Plastic and Reconstructive Surgery at Gulhane Military Medical Academy (Ankara, Turkey) between November 1993-January 2001. Severe soft-tissue defects requiring flap coverage and associated open bone fractures that were treated 7-21 days (mean, 9.6 days) after the injury were included in the study. Twenty-three of 226 extremities (10.2%) underwent primary below-knee amputation. The number of debridements prior to definitive treatment was between 1-3 (mean, 1.9). Gustilo type III open tibia fractures accompanied 104 of 126 soft-tissue defects of the lower leg. Sixty-four bone defects accompanied 83 soft-tissue defects of the feet. Eighteen local pedicled muscle flaps and 208 free muscle flaps (latissimus dorsi, rectus abdominis, and gracilis) were used in soft-tissue coverage of 209 defects. Overall, the free muscle flap success rate was 91.3%. Bone defects were restored with 106 bone grafts, 25 free fibula flaps, and 14 distraction osteogenesis procedures. Osseous and soft-tissue defects were reconstructed simultaneously at the first definitive treatment in 94% of cases. The mean follow-up after definitive treatment was 25 (range, 9-47) months. The average full weight-bearing times for lower leg and feet injuries were 8.4 months and 4 months, respectively. Early, aggressive, and serial debridement of osseous and soft tissue, early restoration of bone and soft-tissue defects at the same stage, intensive rehabilitation, and patient education were the key points in the management of high velocity-high energy injuries of the lower leg and foot.
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Affiliation(s)
- Bahattin Celiköz
- Department of Plastic and Reconstructive Surgery and Burn Unit, Gülhane Military Medical Academy, Haydarpaşa Hospital, Haydarpaşa, Istanbul, Turkey.
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19
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Chang SM, Zhang F, Yu GR, Hou CL, Gu YD. Modified distally based peroneal artery perforator flap for reconstruction of foot and ankle. Microsurgery 2004; 24:430-6. [PMID: 15378572 DOI: 10.1002/micr.20069] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The distally based sural fasciocutaneous flap has been used widely for reconstruction of foot and ankle soft-tissue defects. Here we report on a series of cases of foot and ankle reconstruction with a modified distally based sural flap. The vascular pedicle of the flap includes an axial perforator branch of the peroneal artery and two concomitant veins. This modified distally based perforator flap, measuring around 17 x 6 cm to 30 x 10 cm in size, was transferred for coverage of foot and ankle soft-tissue defects in 7 cases. All flaps survived completely. Neither arterial ischemia nor venous congestion was noted. As compared to other distally based sural flaps with neuro-veno-adipo-fascial pedicles, this modified sural flap with a thin perforator pedicle is easily rotated. The flap can obtain abundant blood supply through both axial perforator and longitudinal chain-linked vascular plexuses, and does not have the venous reflow problem. In conclusion, the invention of this perforator fasciocutaneous flap provides a valuable tool for repair of foot and ankle soft-tissue defects.
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Affiliation(s)
- Shi-Min Chang
- Department of Orthopedic Surgery, Tongji University, Tongji Hospital, 389 Xincun Road, Shanghai 200-065, China.
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Burger H, Marincek C, Jaeger RJ. Prosthetic device provision to landmine survivors in bosnia and herzegovina: outcomes in 3 ethnic groups11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. No official endorsement by the Physical Disabilities Branch, National Institutes of Health is intended or should be inferred. Arch Phys Med Rehabil 2004; 85:19-28. [PMID: 14970963 DOI: 10.1016/j.apmr.2003.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine differences in prosthetic provision, use, and effectiveness among unilateral lower-extremity amputees from 3 ethnic groups in Bosnia and Herzegovina. DESIGN Case series with a consecutive sample of patients seen in field clinics. SETTING Multiple field clinics in Bosnia and Herzegovina from October 1998 to May 2002. PARTICIPANTS A total of 671 patients were examined, and information about their prosthetic history was recorded from observation or verbal responses. The majority of the amputations resulted from injuries inflicted by landmines. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-reported walking distance per day, prosthesis functionality (functional or nonfunctional as assessed by a physician and a prothetist), prosthesis status (broken or nonbroken as assessed by a physician and a prothetist), and employment status. RESULTS Ethnic groups differed significantly in types of prostheses provided, functional status of the prostheses, and use of the prostheses for community ambulation. CONCLUSION Prosthetic devices and delivery of rehabilitation services for unilateral lower-extremity amputees differed between ethnic groups. Despite these differences, functional prosthetic devices increased mobility. Persons in all 3 ethnic groups with functional prostheses were more mobile than persons with nonfunctional prostheses. The employment rate was higher for people with functional prostheses.
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Affiliation(s)
- Helena Burger
- Institute for Rehbilitation, Republic of Slovenia, Ljubljana.
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Chaloner EJ, McMaster J, Hinsley DE. Principles and problems underlying testing the effectiveness of blast protective footwear. J ROY ARMY MED CORPS 2002; 148:38-43. [PMID: 12024891 DOI: 10.1136/jramc-148-01-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Anti-personnel landmines are a continuing threat to soldiers and civilians working overseas in post conflict situations. Several groups of governmental and commercial scientists are currently designing and/or testing footwear to protect the lower leg from the effects of close proximity blast. The general principles surrounding testing of protective footwear are examined together with an assessment of the known progress to date and the strengths and weaknesses of the designs produced.
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