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Turan A. Lower-Extremity Fillet Flap for Reconstruction of Complex Stage IV Pressure Sores and Plantar Flap for Lumbosacral Padding. Ann Plast Surg 2024; 92:230-239. [PMID: 37962214 DOI: 10.1097/sap.0000000000003733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The lower-extremity fillet flap is a suitable option for the repair of complex (multiple or complicated with osteomyelitis) stage IV pressure sores. If prepared from a nonfunctional extremity, it can close complex wounds and avoid the unnecessary burden of a nonfunctional organ that restricts patient movement, thereby improving quality of life. METHODS We used a lower extremity fillet flap for reconstruction in 5 patients with complex stage IV pressure sores. The flaps were prepared from the nonfunctional lower extremity with multiple lesions by using iliofemoral disarticulation. The mean age of the patients was 60 years old, and the mean follow-up period was 18 months. A plantar flap was used in 1 patient for prophylactic padding of the lumbosacral region. In another patient, the plantar flap was used as a sensate flap. RESULTS No major complications, such as total or partial flap loss, occurred in these patients. In 1 patient, a hematoma developed under the flap that led to dehiscence; however, it healed uneventfully without flap loss. Patients developed minimal pelvic stability and balance loss because of iliofemoral disarticulation, but it did not affect their sitting ability and mobility. After the operation, all patients became increasingly active and mobile because of the absence of excess weight on their nonfunctional legs, allowing them to easily perform daily activities such as turning in bed, using a wheelchair, eating, and dressing. Pressure sores did not develop in any of the patients during the postoperative follow-up period. The patient who underwent lumbosacral padding with a sensate plantar flap began to perceive touch over the flap in the fifth postoperative month. CONCLUSIONS These results suggest that a lower-extremity fillet flap can be a good repair option in complex stage IV pressure sores because it prevents recurrence and enables patients to perform daily activities more easily. Furthermore, plantar flaps can provide prophylactic padding in the lumbosacral region.
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Affiliation(s)
- Aydın Turan
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Gaziosmanpaşa University Medical School, Tokat, Turkey
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Dvorak Z, Tomas T, Kubat M, Apostolopoulos V, Tawa N. Free Fillet Lower Leg Flap with Fenestration of The Pelvis as Prevention of Vascular Problem After Hemipelvectomy. J Plast Reconstr Aesthet Surg 2022; 75:2831-2870. [DOI: 10.1016/j.bjps.2022.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022]
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Kiiski J, Laitinen MK, Nail LRL, Kuokkanen HO, Peart F, Rosset P, Bourdais-Sallot A, Jeys LM, Parry MC. Soft tissue reconstruction after pelvic amputation: The efficacy and reliability of free fillet flap reconstruction. J Plast Reconstr Aesthet Surg 2020; 74:987-994. [PMID: 33431341 DOI: 10.1016/j.bjps.2020.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The majority of hindquarter amputation defects can be reconstructed with local anterior or posterior thigh flaps. Less than 5% of soft tissue defects require free flap reconstruction after tumour resection. Lower extremity fillet flap is described for reconstructing such defects, but the majority of publications are case reports or short single institutional series. There is a lack of data regarding the oncological outcomes of this highly selected patient group. METHODS Three tertiary sarcoma units treated twelve patients with hindquarter amputation or hip disarticulation for oncological indications with a free flap reconstruction of the soft tissue defect. RESULTS The median age of patients was 60 (range 12-76) years. Bone resection was carried out through the SI-joint in six patients and through the sacrum in five patients, with one patient undergoing hip disarticulation. Nine patients had R0 resection margin and three had R1 resection. The median surgical time and flap ischaemia time was 420 (249-650) and 89 (64-210) min, respectively. Median hospital and ICU stay was 18 (10-42) and 3 (1-8) days, respectively. Median blood loss was 2400 (950-10000) ml. There were three returns to theatre due to vascular compromise, with one total flap loss due to arterial thrombosis. Overall survival was 58% (95%CI 28-91%) both at 1-year and at 3-years. DISCUSSION Carefully selected patients requiring hindquarter amputation with extensive soft tissue defect necessitating free flap reconstruction can be reconstructed with a lower extremity free fillet flap with low rate of local wound complications. Survival of these patients is similar to that in patients requiring less extensive resection.
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Affiliation(s)
- Juha Kiiski
- Department of Musculoskeletal Surgery and Diseases, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences Tampere, Finland.
| | - Minna K Laitinen
- Helsinki University Hospital, Department of Orthopaedics, Finland; University of Helsinki, Helsinki, Finland
| | - Louis-Romée Le Nail
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Hannu O Kuokkanen
- University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Department of Plastic Surgery, Finland
| | | | - Philippe Rosset
- Orthopaedic Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Aurélie Bourdais-Sallot
- Plastic and Reconstructive Surgery Department, University Hospital of Tours, Medical University of Tours, France
| | - Lee M Jeys
- Royal Orthopaedic Hospital, Birmingham, UK
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Kreutz‐Rodrigues L, Mohan AT, Moran SL, Carlsen BT, Mardini S, Houdek MT, Rose PS, Bakri K. Extremity free fillet flap for reconstruction of massive oncologic resection—Surgical technique and outcomes. J Surg Oncol 2019; 121:465-473. [DOI: 10.1002/jso.25795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/08/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | - Anita T. Mohan
- Division of Plastic Surgery, Department of SurgeryMayo Clinic Rochester Minnesota
| | - Steven L. Moran
- Division of Plastic Surgery, Department of SurgeryMayo Clinic Rochester Minnesota
- Department of Orthopedic SurgeryMayo Clinic Rochester Minnesota
| | - Brian T. Carlsen
- Division of Plastic Surgery, Department of SurgeryMayo Clinic Rochester Minnesota
- Department of Orthopedic SurgeryMayo Clinic Rochester Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Department of SurgeryMayo Clinic Rochester Minnesota
| | | | - Peter S. Rose
- Department of Orthopedic SurgeryMayo Clinic Rochester Minnesota
| | - Karim Bakri
- Division of Plastic Surgery, Department of SurgeryMayo Clinic Rochester Minnesota
- Department of Orthopedic SurgeryMayo Clinic Rochester Minnesota
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Kreutz-Rodrigues L, Weissler JM, Moran SL, Carlsen BT, Mardini S, Houdek MT, Rose PS, Bakri K. Reconstruction of complex hemipelvectomy defects: A 17-year single-institutional experience with lower extremity free and pedicled fillet flaps. J Plast Reconstr Aesthet Surg 2019; 73:242-254. [PMID: 31703941 DOI: 10.1016/j.bjps.2019.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/31/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Hemipelvectomy procedures result in massive soft tissue defects. The standard approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps. Certain situations preclude the use of local tissue flaps, and an alternative is the use of leg fillet flaps, circumferential pedicled or free flaps harvested from the amputated part. The purpose of this study is to present our institution's experience with using pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. METHODS We performed a retrospective chart review of patients who underwent hemipelvectomy and fillet flap reconstruction from 2001 to 2018. Demographics, clinical and surgical characteristics, postoperative outcomes, and complications of patients were reviewed. RESULTS Ten patients were identified and included. Their mean age was 51 ± SD 12.4 years. Six patients underwent standard external hemipelvectomy and 4 patients underwent extended external hemipelvectomy. Seven lower extremity fillet flaps were performed as free tissue transfers, and 3 were pedicled flaps. The mean flap size was 1,153 ± SD 1137 cm2. The mean follow-up was 5 months (range: 1-24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively. CONCLUSION Reconstruction with pedicled or free lower extremity fillet flaps is a valuable reconstructive approach, for managing large soft tissue defects following hemipelvectomy when the standard anterior and posterior thigh flaps are unavailable or inadequate for complete soft tissue coverage. This useful technique mitigates donor site morbidity, while simultaneously achieving massive soft tissue coverage with an acceptable complication profile.
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Affiliation(s)
- Lucas Kreutz-Rodrigues
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jason M Weissler
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Steven L Moran
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Brian T Carlsen
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
| | - Karim Bakri
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States.
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Sánchez-García A, Pérez-García A, Salmerón-González E, Thione A, García-Vilariño E, Salom M, Baixauli F, Simón-Sanz E. The Spare Parts Concept in Sarcoma Surgery: A Systematic Review of Surgical Strategies. ACTA ACUST UNITED AC 2019. [DOI: 10.29337/ijops.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Roulet S, Le Nail LR, Vaz G, Babinet A, Dumaine V, Sallot A, Rosset P. Free fillet lower leg flap for coverage after hemipelvectomy or hip disarticulation. Orthop Traumatol Surg Res 2019; 105:47-54. [PMID: 30595412 DOI: 10.1016/j.otsr.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/26/2018] [Accepted: 10/18/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tumor resection is the gold standard treatment for soft tissue and bone sarcomas. In the pelvis, this may require a hemipelvectomy that can compromise primary skin closure. Flaps are essential in this context; however the vascularization of potential pedicled flaps may have been removed during tumor excision. Using healthy tissue from the amputated limb as a free flap is an excellent coverage option. HYPOTHESIS The free fillet flap from an amputated lower limb is a simple and reliable coverage technique after hemipelvectomy or hip disarticulation. MATERIAL AND METHODS Seven patients were operated on at three specialty centers: six transpelvic amputations (external hemipelvectomy) and one hip disarticulation. In three cases, the flap consisted of the superficial posterior compartment of the calf area and in the three other cases, the lower leg compartments with the fibula and its intact periosteum. Complications were documented. RESULTS Clear resection margins were achieved in all patients. The mean follow-up at the final visit was 13 months (range, 6.5 to 21 months). Six patients had complications but only one resulted in loss of the flap. Four patients were able to be fitted with a hip prosthesis. DISCUSSION The free fillet flap from an amputated lower limb is a reliable coverage technique (86%) after hemipelvectomy or hip disarticulation. In the 16 cases previously reported in the literature, there were no wound-healing failures. Local flaps are often too fragile with insufficient muscular padding. This free flap is the preferred first-line technique as it spares other potential free flaps in case of failure without increasing the morbidity of a procedure that is already extensive. This coverage technique should be one the options considered after external hemipelvectomy. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Steven Roulet
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France.
| | - Louis-Romée Le Nail
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France
| | - Gualter Vaz
- Département de chirurgie oncologique, centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - Antoine Babinet
- Département de chirurgie orthopédique et reconstructive, centre hospitalo-universitaire Cochin - Port Royal, 27, rue du Faubourg Saint-Jacque, 75014 Paris, France
| | - Valérie Dumaine
- Département de chirurgie orthopédique et reconstructive, centre hospitalo-universitaire Cochin - Port Royal, 27, rue du Faubourg Saint-Jacque, 75014 Paris, France
| | - Aurélie Sallot
- Département de chirurgie plastique et reconstructive, centre hospitalo-universitaire de Tours - faculté de médecine, université de Tours, 37000 Tours, France
| | - Philippe Rosset
- Département de chirurgie orthopédique 2, centre hospitalo-universitaire Tours - faculté de medecine, université de Tours, 37000 Tours, France; Inserm UN UMR 1238, PhyOs, bone sarcomas and remodeling of calcified tissues, faculté de médecine de Nantes, 44000 Nantes, France
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Strong B, Ragbir M. Re: A simplified approach to reconstruction of hemipelvectomy defects with lower extremity free fillet flaps to minimize ischaemia time. J Plast Reconstr Aesthet Surg 2016; 69:727. [PMID: 26906555 DOI: 10.1016/j.bjps.2016.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/24/2016] [Indexed: 11/16/2022]
Affiliation(s)
- B Strong
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
| | - M Ragbir
- Department of Plastic Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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