A review of the Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe (TOPHAT) flap for wound coverage during ray amputations of the toes
| Autor: | Manfred Mak, Q.Y. Tan, Jerilyn Tan, Tze Tec Chong, N. Sim, Hao Yun Yap, Hsien Tsung Tay, A. Chau, Shaun Q.W. Lee, D. Wong |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Secondary infection medicine.medical_treatment Amputation Surgical Surgical Flaps 03 medical and health sciences 0302 clinical medicine Negative-pressure wound therapy Joint capsule Medicine Humans Orthopedics and Sports Medicine Podiatry Retrospective Studies 030203 arthritis & rheumatology Gangrene integumentary system business.industry Wound dehiscence Soft tissue 030229 sport sciences Toes medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Amputation Skin grafting business Negative-Pressure Wound Therapy |
| Zdroj: | Foot (Edinburgh, Scotland). 47 |
| ISSN: | 1532-2963 |
| Popis: | Introduction Exposure of the adjacent Metatarsal-Phalangeal Joint (MTPJ) commonly occurs after application of Topical Negative Pressure Wound Therapy (TNPWT) for a ray amputation wound. This is due to mechanical soft tissue erosion or trauma to the adjacent digital artery from direct pressure effect. This results in toe gangrene requiring a ray amputation and ultimately a larger wound bed. We describe the use of the Turned-down Onto Pericapsular-tissue Hemisectioned Amputated Toe (TOPHAT) flap – a filleted toe flap to protect the adjacent MTPJ capsule combined with a novel Negative Pressure Wound Therapy with instillation and dwell-time (NPWTi-d) dressing technique. The flap protects the adjacent joint capsule and reduces the wound burden whilst allowing the wound to benefit from TNPWT, thereby accelerating wound healing. Material and methods A retrospective review was conducted of patients with toe gangrene requiring ray amputation that underwent the TOPHAT flap on in our institution from 2019 and 2020. Complications such as wound dehiscence, hematoma, flap necrosis and secondary infection were recorded. Other outcomes recorded were time taken to final skin grafting and time taken for complete wound epithelialization. Results 9 patients underwent treatment with the TOPHAT flap. 2 patients had flap necrosis. 7 patients progressed to definitive skin coverage with skin grafting. One patient subsequently had progressive arterial disease despite successful skin grafting and required above knee amputation. The mean time to final skin grafting and complete wound epithelialization was 49.5 days and 107.5 days respectively. All patients were satisfied with the outcomes and were able to return to their pre-morbid function. Conclusions The TOPHAT flap has a consistent vascular supply that provides durable soft tissue coverage. It is a robust and easily reproducible technique to accelerate wound healing after ray amputations even in patients with peripheral vascular disease. |
| Databáze: | OpenAIRE |
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