Use of a local fasciocutaneous flap for treatment of exposed vascular grafts to the dorsalis pedis artery

Coverage Strategies in Exposed Implants

Implants are widely used and are not without complications. The most serious complication is infection with consequent exposure of the implant and is characterized by increased morbidity and mortality. Until recently, infected implants were removed and replaced with another one. These operations are accompanied by increased morbidity and might result in permanent disability. Coverage of the implant with a flap is an alternative solution. The objective of this article is to study the effectiveness of muscle or myocutaneous flaps in covering infected and exposed implants. A series of 17 patients with infected implants, which were treated with coverage of the implant with muscle or myocutaneous flap, is presented. Eight patients had an orthopedic implant, seven a vascular implant, and two had a pacemaker. The flaps ensured immediate coverage of the implant and the biologic ability of eliminating the infectious process with the increased concentration of antibiotics resulting from increased blood flow of the muscle. In all the patients, the implants were preserved and the infectious process was eliminated. The use of muscle and myocutaneous flaps in the treatment of infected implants is therefore effective and in some cases it is superior to other methods because of lower morbidity and cost.

The Clinical Importance of the Relationship between the Deep Peroneal Nerve and the Dorsalis Pedis Artery on the Dorsum of the Foot

BACKGROUND

The aim of this study was to describe the relationship between the deep peroneal nerve and the dorsalis pedis artery to help ensure a safer surgical approach in flap surgery.

METHODS

The dissection of 36 cadaver lower limbs was undertaken to describe the relationship of the deep peroneal nerve to the dorsalis pedis artery in the anterior tarsal tunnel and on the dorsum of the foot.

RESULTS

Four distinct relationships of the deep peroneal nerve to the dorsalis pedis artery were determined. In type 1 (36.1 percent), the artery was medial to the deep peroneal nerve in the tunnel and medial to the medial terminal branch below the tunnel on the dorsum of the foot. In type 2 (25.0 percent), the artery was medial to the deep peroneal nerve in the tunnel and lateral to the medial terminal branch below the tunnel on the dorsum of the foot. In type 3 (30.6 percent), the deep peroneal nerve and the artery were crossing over each other at multiple levels. In type 4 (8.3 percent), no medial terminal branch was observed. The artery was medial to the lateral terminal branch.

CONCLUSIONS

The dorsalis pedis neurovascular island flap contains both the dorsalis pedis artery and the deep peroneal nerve. Because the design of a neurovascular free flap requires detailed knowledge of the nerve and vascular supply, the data presented here will help surgeons during the surgical approaches to the foot and ankle.

Let it be: Salvage of exposed hemodialysis grafts with fasciocutaneous island flaps

Contaminated and exposed prosthetic implants have traditionally required surgical explantation. This has been standard treatment, particularly for implants in the central circulation or those bridging major vascular structures, such as hemodialysis grafts. We present our experience in salvaging exposed hemodialysis grafts utilizing regional fascio- and septo-cutaneous flaps. In 5 of 6 cases, graft salvage was achieved, obviating the need for explantation and de novo insertion at another location. In selected instances of hemodialysis graft exposure, wound coverage and graft function can be obtained with regionally based flaps.