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Tan CH, Wu Y, Satkunanantham M. Flaps for lower limb diabetic wound reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 79:74-86. [PMID: 36870103 DOI: 10.1016/j.bjps.2023.01.032] [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: 08/26/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The treatment of chronic diabetic wounds includes wound dressing, debridement, flap surgery, and amputation. For suitable patients with nonhealing wounds, locoregional flaps or free flaps may be used. This paper aims to review the outcomes of flap surgery and identify the risk factors for flap loss. METHODS MEDLINE, Embase, and Cochrane Library were searched. Articles reporting flap loss outcomes for flap surgery in lower limb chronic diabetic wounds were included. Case reports and case series with fewer than five patients were excluded. A subset of articles was used for revascularization subgroup analysis and another subset for meta-analysis of risk factors for flap loss. RESULTS In the free flap group, the total flap failure rate was 7.14% and partial flap failure rate was 7.54%. The rate of major complications requiring operative takeback was 19.0%. Early mortality was 2.76%. In the locoregional flap group, the total flap failure rate was 3.24% and partial flap failure rate was 5.36%. The rate of major complications requiring operative takeback was 13.3%. There was no early mortality. The rate of free flap loss was 18.2% with revascularization, significantly higher than 6.66% without revascularization. CONCLUSIONS Our findings concur with previously published studies on flap loss and complications in diabetic lower limb wounds. There is an increased risk of flap loss in patients who require free flap and revascularization compared to patients who only require free flap. This could be because of the fragile and fibrotic vessels found in diabetics with comorbid atherosclerosis.
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Affiliation(s)
| | | | - Mala Satkunanantham
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore
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Tripathee S, Basnet SJ, Lamichhane A, Hariani L. How Safe Is Reverse Sural Flap?: A Systematic Review. EPLASTY 2022; 22:e18. [PMID: 35873071 PMCID: PMC9275416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Soft tissue reconstruction of the lower third of the leg, the ankle, and the foot is challenging for reconstructive surgeons. The options for reconstruction are limited. Reverse sural flap is relatively easy to perform and considered a good option for reconstruction. The complication rates are variable in studies. This study aims to systemically review all available articles based on reverse sural flap focusing on complications of the flap. The overall complication of the flap helps to better understand the reliability of the flap. METHODS A comprehensive literature search was performed using MEDLINE, EMBASE, and Google Scholar to identify cases of reverse sural artery flap. RESULTS A pooled analysis of 89 articles was performed, which yielded 2575 patients (2592 flaps) over a period of 19 years. Most of the cases were performed in Asian countries (1540 flaps, 59.4%) with the majority being performed in China (746 flaps, 28.8%). The most common cause for reverse sural flap surgery was trauma/postsurgical (1785/2592) followed by burn/scarring. Flap complications were recorded in 653 of 2592 flaps (25.20%). The most common complication was partial flap loss, which was recorded in 204 flaps (7.85%) followed by venous congestion (79 flaps, 3.05%). Complete flap loss was observed only in 66 participants (2.5% of all the flaps performed). CONCLUSIONS Reverse sural flap is reliable flap for the reconstruction of lower leg, ankle, and foot. It can give a comparable outcome as free flap when meticulously performed and, in many cases, a better result.
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Affiliation(s)
| | | | | | - Lynda Hariani
- Nepal Plastic Cosmetic and Laser Center, Lalitpur, Nepal
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Flap Venous Congestion and Salvage Techniques: A Systematic Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3327. [PMID: 33564571 PMCID: PMC7858245 DOI: 10.1097/gox.0000000000003327] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Venous congestion is a frequent problem in flap surgery. Other than surgical revision, there are a multitude of procedures in the literature to tackle this problem, but their effectiveness is not clear. Through a systematic review, we aimed to identify and evaluate the different interventions available for managing flap venous congestion. Methods The MEDLINE, PubMed central, Embase, and Cochrane databases were searched. The study selection process was adapted from the PRISMA statement. All English and French original articles describing or comparing a method for managing flap venous congestion were included. For each article, a level of evidence was assigned, as defined by the Oxford Centre for Evidence-based Medicine. Lastly, we specifically analyzed the effectiveness of postoperative non-surgical methods. No formal analysis was performed. Results Through literature searches carried out in various databases, we identified 224 articles. Finally, 72 articles were included. The majority of these studies had a low-level evidence. A total of 17 different methods (7 pre- and intraoperative, and 10 postoperative) were found. Concerning non-surgical methods, the most represented were leeches, local subcutaneous injection of heparin with scarification, venocutaneous catheterization, negative pressure therapy, and hyperbaric oxygen therapy. Conclusions Risks of venous congestion of flaps must always be present in a surgeon's mind, at every stage of flap surgery. Apart from studies on the use of leeches, which have a significant follow-up and large enough patient numbers to support their efficacy, the low-level evidence associated with studies of other methods of venous congestion management does not allow us to draw a scientifically valid conclusion about their effectiveness.
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Revisiting the Reverse Sural Artery Flap in Distal Lower Extremity Reconstruction. Ann Plast Surg 2020; 84:463-470. [DOI: 10.1097/sap.0000000000002041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Luo Z, Lv G, Wei J, Ni J, Liu L, Peng P, Dong Z. Comparison between distally based peroneal and posterior tibial artery perforator-plus fasciocutaneous flap for reconstruction of the lower extremity. Burns 2020; 46:225-233. [DOI: 10.1016/j.burns.2019.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/26/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
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Hasenstein TA, Greene T, Van JC, Meyr AJ. Soft Tissue Reconstruction with Diabetic Foot Tissue Loss. Clin Podiatr Med Surg 2019; 36:425-440. [PMID: 31079608 DOI: 10.1016/j.cpm.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although substantial advances have been made in treatment of diabetic foot disease with respect to patient education, preventative measures, early intervention, and prophylactic procedures, most surgical interventions for this condition are reactionary. Patients still primarily present to emergency departments with acute infections and tissue necrosis. The surgical intervention for this results in soft tissue deficit, often with partial foot amputation, through excisional debridement of pathologic tissue. Minimizing this initial soft tissue loss, with subsequent reconstruction of the defect, forms the focus of this article with a detailed anatomic assessment of structures at risk in the forefoot, midfoot and rearfoot.
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Affiliation(s)
- Todd A Hasenstein
- Temple University Hospital Podiatric Surgical Residency Program, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Timothy Greene
- Temple University Hospital Podiatric Surgical Residency Program, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Jennifer C Van
- Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Andrew J Meyr
- Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA.
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Bristow PC, Perry KL, Halfacree ZJ, Lipscomb VJ. Use of vacuum-assisted closure to maintain viability of a skin flap in a dog. J Am Vet Med Assoc 2016; 243:863-8. [PMID: 24004235 DOI: 10.2460/javma.243.6.863] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 4-year-old sexually intact male Labrador Retriever-Poodle mix was admitted to the hospital for treatment of a wound in the left thoracic region. The wound had been debrided and primary closure had been performed by the referring veterinarian 4 days previously. CLINICAL FINDINGS The dog had a 20-cm-long wound covered by a large flap of skin that extended caudally from the scapula over the left side of the thorax. A 3-cm defect was evident at the cranioventral aspect of the wound, from which purulent material was being discharged. The skin flap was necrotic, and the skin surrounding the flap was bruised. Signs of pain were elicited when the wound and surrounding region were palpated. Other findings, including those of thoracic radiography, were unremarkable. TREATMENT AND OUTCOME The wound was debrided, and vacuum-assisted closure (VAC) was initiated for 3 days until a healthy bed of granulation tissue developed. A reconstructive procedure was performed with a rotation flap 3 days after VAC dressing removal. The VAC process was reinitiated 2 days following reconstruction because of an apparent failing of the skin flap viability. After 5 days of VAC, the flap had markedly improved in color and consistency and VAC was discontinued. Successful healing of the flap occurred without the need for debridement or additional intervention. CLINICAL RELEVANCE Use of VAC led to a good overall outcome for the dog, with complete healing achieved. Additional evaluation of this technique for salvaging failing skin flaps is warranted in dogs, particularly considering that no reliable method for flap salvage in veterinary species has been reported to date.
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Affiliation(s)
- Poppy C Bristow
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, North Mymms, Hatfield, Hertfordshire, AL9 7TA, England.
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Qiu SS, Hsu CC, Hanna SA, Chen SHY, Cheong CF, Lin CH, Chang TNJ. Negative pressure wound therapy for the management of flaps with venous congestion. Microsurgery 2016; 36:467-73. [PMID: 26806399 DOI: 10.1002/micr.30027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 12/08/2015] [Accepted: 12/31/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this report is to evaluate the utility of negative pressure wound therapy (NPWT) for rescuing flaps with venous congestion not attributable to a mechanical etiology and that cannot be surgically salvaged. PATIENTS AND METHODS A total of 12 patients suffered from partial or total flap congestion after pedicle or free-flap reconstruction was included. All patients underwent NPWT between 3 and 10 days postoperatively. RESULTS All congested flaps survived after the application of NPWT. Nine patients suffered partial flap loss and this was addressed through debridement of the devitalized tissue and primary closure. Three patients required blood transfusions during the course of their management. All patients presented complete coverage of the defects without further problems in the flaps after the treatment. CONCLUSION NPWT may be considered an alternative management strategy for flaps, which has undergone venous congestion not due to a mechanical cause. © 2016 Wiley Periodicals, Inc. Microsurgery 36:467-473, 2016.
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Affiliation(s)
- Shan Shan Qiu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Tao-Yuan, Taiwan.,Department of Plastic Surgery, Maastrich University Medical Center, Maastricht, the Netherlands
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Tao-Yuan, Taiwan
| | | | - Sirena Hsin-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Tao-Yuan, Taiwan
| | - Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Tao-Yuan, Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Tao-Yuan, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang-Gung University, School of Medicine, Tao-Yuan, Taiwan.
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Reconstruction of Ankle and Heel Defects with Peroneal Artery Perforator-Based Pedicled Flaps. Arch Plast Surg 2015; 42:619-25. [PMID: 26430635 PMCID: PMC4579175 DOI: 10.5999/aps.2015.42.5.619] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. METHODS From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. RESULTS The mean age of the patients was 52.4 years. The size of the flaps ranged from 5×4 to 20×8 cm(2). The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. CONCLUSIONS Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.
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Suzuki T, Minehara A, Matsuura T, Kawamura T, Soma K. Negative-pressure wound therapy over surgically closed wounds in open fractures. J Orthop Surg (Hong Kong) 2014; 22:30-4. [PMID: 24781609 DOI: 10.1177/230949901402200109] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the outcome of open fracture surgery with negative-pressure wound therapy (NPWT) applied directly over surgical wounds. METHODS Medical records of 10 men and 4 women aged 6 to 70 (mean, 43.7) years who underwent internal fixation, external fixation, or splint application for open fractures of the lower leg (n=7), foot and ankle (n=5), or knee (n=2), and NPWT were reviewed. The NPWT was applied directly over the surgical wound without a non-adherent contact layer. The foam was changed every 3 days. The standard negative pressure was 125 mm Hg. The NPWT was stopped when the wound discharge became <50 ml per day. The duration of NPWT and the level of negative pressure were recorded, as were wound condition, reasons for NPWT, and outcome. RESULTS The mean duration of NPWT was 9.1 (range, 3-24) days. Four patients developed maceration of the skin under the foam, whereas 2 patients developed skin blisters under the drape. No necrosis of flap skin or infection occurred, and all the fractures eventually united. CONCLUSIONS Maceration of the skin was seen in some cases but did not affect the overall outcome. NPWT directly over the skin surface had no deleterious effect on wound and fracture healing.
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Affiliation(s)
- Takashi Suzuki
- Emergency Medical Center, Kitasato University Hospital, Sagamihara, Japan
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11
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de Blacam C, Colakoglu S, Ogunleye AA, Nguyen JT, Ibrahim AMS, Lin SJ, Kim PS, Lee BT. Risk factors associated with complications in lower-extremity reconstruction with the distally based sural flap: a systematic review and pooled analysis. J Plast Reconstr Aesthet Surg 2014; 67:607-16. [PMID: 24662152 DOI: 10.1016/j.bjps.2014.01.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 01/17/2014] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Abstract
The distally based sural fasciocutaneous flap is one of the few options available for local flap reconstruction of soft-tissue defects in the lower one-third of the leg. Few studies have assessed risk factors associated with poor outcomes in this flap. A literature search was performed of MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles evaluating the use of sural artery fasciocutaneous flaps for soft-tissue reconstruction of the leg. Data were pooled and a univariate analysis was performed to identify characteristics associated with increased morbidity. A logistic regression model was created, and odds ratios and p values associated with the development of complications were calculated. Sixty-one papers were identified which included data on 907 patients. The majority of sural flaps were used to cover defects of the heel (28.2%), foot (14.4%) or ankle (25.8%). Trauma was the most common indication, followed by ulcers and open fractures. Flap complications were recorded in 26.4% of cases with a flap loss rate of 3.2%. With multivariate analysis, venous insufficiency and increasing age were independent risk factors for complications. Patients with venous insufficiency had nine times the risk of developing a complication compared to patients without venous insufficiency.
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Affiliation(s)
- Catherine de Blacam
- Plastic Surgery Higher Surgical Training Scheme, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Salih Colakoglu
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adeyemi A Ogunleye
- Department of Surgery, Harlem Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - John T Nguyen
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ahmed M S Ibrahim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J Lin
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter S Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Bernard T Lee
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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12
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Panagakos P, McDonald P, Norem N, Shapiro H, Boc SF, Mitra A. De-epithelialized fasciocutaneous turnover flap for recurrent calcaneal wound with osteomyelitis. J Foot Ankle Surg 2013; 53:83-7. [PMID: 23910737 DOI: 10.1053/j.jfas.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Indexed: 02/03/2023]
Abstract
Recurrent ulcerations of the foot and ankle almost always present a challenge to lower extremity surgeons. Recalcitrant heel ulcerations with osteomyelitis are especially difficult to treat because of the lack of soft tissue coverage. The turnover flap is a simple, fast, and effective treatment method for lower extremity wounds. It is a de-epithelialized fasciocutaneous flap harvested from the adjacent area of the wound. We believe it is an underused technique for advanced wound closure in the lower extremity. It offers several advantages compared with traditional, more difficult to perform, flaps. We have seen an excellent result 18 months after using the turnover flap in a patient with recurrent posterior heel ulceration with calcaneal osteomyelitis.
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Affiliation(s)
| | - Patrick McDonald
- Associate, Mountain Valley Orthopedics, PC, East Stroudsburg, PA
| | - Nathan Norem
- Chief Resident, Podiatric Medicine and Surgery, Hahnemann University Hospital, Philadelphia, PA
| | - Howard Shapiro
- Assistant Director, Podiatric Medicine and Surgery Residency, Hahnemann University Hospital, Philadelphia, PA
| | - Steven F Boc
- Director, Podiatric Medicine and Surgery Residency, Hahnemann University Hospital; Assistant Professor of Surgery, Drexel College of Medicine, Philadelphia, PA
| | - Amit Mitra
- Chief, Plastic Surgery Department, Hahnemann University Hospital, Philadelphia, PA
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14
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Abstract
Lower extremity diabetic wounds have been a challenge to clinical surgeons because of the higher risk of limb ischemia, soft-tissue infection, and soft-tissue loss caused by the pathology of the disease. In the published data, the most commonly used reconstruction techniques include pedicled flaps, microsurgical muscle or musculocutaneous flaps, and microsurgical fasciocutaneous or perforator flaps. However, there is still no consensus about which type of flap should be preferred among various reconstructive options. It is therefore the aim of this study to review current articles describing distal lower extremity flap reconstruction in patients with diabetes to survey reported results from the literature.
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Influence of flap factors on partial necrosis of reverse sural artery flap. J Trauma Acute Care Surg 2012; 72:744-50. [DOI: 10.1097/ta.0b013e31822a2f2b] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wolff KD, Bauer F, Kunz S, Mitchell DA, Kesting MR. Superficial lateral sural artery free flap for intraoral reconstruction: Anatomic study and clinical implications. Head Neck 2011; 34:1218-24. [DOI: 10.1002/hed.21885] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/16/2011] [Accepted: 06/27/2011] [Indexed: 11/11/2022] Open
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Birke-Sorensen H, Malmsjo M, Rome P, Hudson D, Krug E, Berg L, Bruhin A, Caravaggi C, Chariker M, Depoorter M, Dowsett C, Dunn R, Duteille F, Ferreira F, Martínez JF, Grudzien G, Ichioka S, Ingemansson R, Jeffery S, Lee C, Vig S, Runkel N, Martin R, Smith J. Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) – Steps towards an international consensus. J Plast Reconstr Aesthet Surg 2011; 64 Suppl:S1-16. [DOI: 10.1016/j.bjps.2011.06.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/22/2011] [Accepted: 06/03/2011] [Indexed: 01/14/2023]
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Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus. Injury 2011; 42 Suppl 1:S1-12. [PMID: 21316515 DOI: 10.1016/s0020-1383(11)00041-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
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Parrett BM, Pribaz JJ, Matros E, Przylecki W, Sampson CE, Orgill DP. Risk Analysis for the Reverse Sural Fasciocutaneous Flap in Distal Leg Reconstruction. Plast Reconstr Surg 2009; 123:1499-1504. [DOI: 10.1097/prs.0b013e3181a07723] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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