Coverage of exposed ankle and foot with the conjoined lower abdomen and groin flaps

Reconstruction of the severe Achilles tendon and soft-tissue loss with the bi-pedicled conjoined flap and vascularized fasciae latae: A consecutive case series of 15 patients

BACKGROUND

Historically, the segmental loss of the Achilles tendon with overlying soft-tissue defects had been frequently reconstructed with the composite anterolateral thigh (ALTP) flap, including the iliotibial tract or fasciae latae. This study aimed to present our modified combination using the bi-pedicled conjoined flap with vascularized fasciae latae, for the approximately total reconstruction of the Achilles tendon and extensive soft tissue.

METHODS

From May 2015 to March 2018, 15 patients (9 male and 6 female) with a mean age of 36 years (ranged, 18-52 years) underwent microvascular Achilles tendon reconstruction. Harvested on the abdomen and groin, the conjoined flap was chimeric with the vascularized fasciae latae. Primary donor-site closure was accomplished in all patients. A standard assessment of the functional and esthetical outcomes was completed.

RESULTS

Mean follow-up time was 42 months (ranged, 32-48 months). The average dimension of the conjoined flap was 25 × 14 cm (ranged, 18 × 10-35 × 18 cm), and the average size of the folded fasciae latae was 15 × 6 cm (ranged, 12 × 5-25 × 8 cm). At the last follow-up, the Thompson test was negative in all patients. The mean American Orthopedic Foot and Ankle Society (AOFAS) score was 91.0. The mean Achilles tendon total rupture score (ATRS) was 18.5. The mean Vancouver Scar Scale (VSS) score was 3.0.

CONCLUSIONS

The composite bi-pedicled flap including vascularized fasciae latae provides an alternative approach with great functional and esthetic outcomes, in selected patients who suffered severe Achilles tendon and skin defects. The one-stage procedure facilitates better rehabilitation postoperatively.

Clinical application of digital technology in the reconstruction of soft tissue defects of the lower extremity with free superficial circumflex iliac artery flap

Objective

This paper aims to investigate the feasibility and clinical effectiveness of digital technology in the clinical application of free superficial circumflex iliac artery flap (SCIP) for repairing soft-tissue defects in the lower extremities.

Methods

From January 2020 to December 2021, 16 patients with lower extremity soft tissue defects requiring flap repair were selected, and preoperative 3D digital reconstruction of the abdominal donor area and lower extremity recipient area were performed using digital technology combined with highly selective abdominal computed tomography angiography, and virtual design and flap cutting were performed using the software self-contained tool. During the actual surgery, the intraoperative design and excision of the superficial iliac circumflex artery were guided by the preoperative digital design, and the donor sites of the flap were closed directly.

Results

In all cases, digital models of the donor area of the abdominal SCIP were successfully established, which could clearly showed the distribution, course, and diameter of the main trunk and the perforators and other relevant anatomical information and successfully guided the design and excision of the flap during surgery. All flaps successfully survived after surgery, and both the flap recipient and donor sites healed in one stage. All patients were followed up for 2–12 months on average (mean 8.6 months), and the flaps were not bulky and had a satisfactory appearance, with no significant difference in color compared with the surrounding skin and a little pigmentation around the flap. Only linear scarring was left in the donor areas, and there was no restriction of hip movement.

Conclusion

This study used digital technology combined with a SCIP to repair lower extremity soft-tissue defects. The preoperative three-dimensional reconstruction of the digital model of the flap optimally designed the surgical plan, reduced the surgical risk and difficulty, shortened the surgical time, and had some significance for clinical precision, safety, and personalized design of the abdominal flap.