Distal lower extremity coverage by distally based sural flaps: Methods to increase their vascular reliability

Autor: François Canovas, Guillaume Captier, M. Hamoui, Raphael Sinna, Christian Herlin, Benoit Chaput
Přispěvatelé: Département de chirurgie infantile [CHRU de Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), CHU Amiens-Picardie, Laboratoire d'Anatomie, Université Montpellier 1 ( UM1 ), Université de Montpellier ( UM ), CHU Toulouse [Toulouse], Département Chirurgie Pédiatrique [CHRU Montpellier], Pôle Femme Mère Enfant [CHRU Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Laboratoire d'Anatomie [CHU Montpellier], Université de Montpellier (UM)
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Soft Tissue Injuries
Adolescent
medicine.medical_treatment
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
030230 surgery
Anastomosis
03 medical and health sciences
Small saphenous vein
Short Saphenous Vein
0302 clinical medicine
medicine
Lambeau fasciocutané
Lambeau neurocutané
Humans
Saphenous Vein
Lambeau adipofascial
[ SDV.MHEP.CHI ] Life Sciences [q-bio]/Human health and pathology/Surgery
Ligature
Child
Lambeau sural à pédicule distal
Aged
Retrospective Studies
Aged
80 and over
business.industry
Dissection
Neurocutaneous flaps
Fasciocutaneous flaps
Microsurgery
Middle Aged
Plastic Surgery Procedures
Skin paddle
Surgery
Distally based sural flaps
Treatment Outcome
Lower Extremity
030220 oncology & carcinogenesis
Adipofascial flaps
Female
Ligation
business
Perforator Flap
Follow-Up Studies
Zdroj: Annales de Chirurgie Plastique Esthétique
Annales de Chirurgie Plastique Esthétique, Elsevier Masson, 2017, 62 (1), pp.45-54. 〈10.1016/j.anplas.2015.11.002〉
Annales de Chirurgie Plastique Esthétique, Elsevier Masson, 2017, 62 (1), pp.45-54. ⟨10.1016/j.anplas.2015.11.002⟩
ISSN: 0294-1260
DOI: 10.1016/j.anplas.2015.11.002〉
Popis: Summary Introduction Although using distally based sural flaps is old and common, the described harvesting methods vary and often depend on unclear vascular anatomical data. We wanted, through a review of the existing harvesting techniques and our clinical experience, to synthesize these aspects in order to provide an optimal, safe and customized use of distally based sural flaps. Patients and methods Fifty-eight sural flaps were performed in 53.4-year-old patients in average, presenting in 81% of the cases one or more vascular comorbidities. The mean cover surface was of 30 cm 2 . The flaps were mainly fasciocutaneous. The tunneling of the pedicle was performed in 34.5% of the cases. A skin blade was preserved above the pedicle in 37.9% of flaps. The short saphenous vein was anastomosed in 27.6% of the cases at the recipient site and ligatured distally in 19% of the cases. The mean follow-up was 18.9 months. Results In 31% of cases, the skin paddle presented an obvious venous congestion during flap inset successfully treated with an anastomosis or a distal ligature of the short saphenous vein. We noticed in six other flaps (10.3%) a postoperative venous congestion having led to a skin paddle partial necrosis, of which five (8.6%) were treated without compromising the quality of the reconstruction. One patient required a coverage using another flap. Conclusion When the microsurgery is not required or possible, the distally based sural flaps represent a safe level of the reconstructive armamentarium. Managing the pedicle's dissection and the venous drainage needs to be discussed case-by-case and adapted to peroperatory observations. The anastomosis or ligation of the small saphenous vein, as the existence of a thin skin blade under the skin paddle appear to increase vascular reliability of these flaps.
Databáze: OpenAIRE
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