Combination of Perforator Flaps for Reconstructive Surgery in the Lower Leg: A Clinical Study on High-Risk Patients with Posttraumatic Osteomyelitis
نویسندگان
چکیده
Introduction: Several studies report good results of single perforator flap transfers for reconstruction of soft-tissue defects at the lower leg and the foot. The novel aspect of our study is application on combination of hinged perforator flaps transfers in high-risk patients with post-traumatic osteomyelitis. Materials and Methods: The study was conducted as a retrospective clinical trial from 2006 to 2014. In sixteen patients, a total of 35 distally hinged sural, saphenous and supramalleolar perforator flaps were used in multiple fashion as a planned combination or reconciliation of unsuccessful initial flap transfers to cover the soft tissue defects on post-injury chronic osteomyelitis in the distal tibia. Results: The soft tissue defects were large; mean 48 cm2 (SD 20). Most patients had severe osteomyelitis, Cierny-Mader (CM) grade III or IV. A total of 13 sural, 14 saphenous, eight supramalleolar and two Ponten flaps were transferred with a failure rate at the first stage of surgery at 19% (95% CI 9 36); at the second stage of surgery all flaps healed. The osteomyelitis severity was a risk factor for flap failure: no failures were observed in CM grade-III patients while 24% of the flaps failed in patients with CM grade-IV (85%CI diff 3 40). Conclusion: A combination of perforator flaps is useful in the management of post-traumatic osteomyelitis in the distal lower leg. With a multi-flap approach, bifocal separated soft tissue defects can be covered, and second-stage transfer of a flap based on the neighbour angiosome may mend unsuccessful initial flap transfers.
منابع مشابه
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