practice
Management of post road traffic accident compound leg defects using fasciocutaneous flaps l Objective: To highlight the role of fasciocutaneous flaps in the management of leg and foot defects sustained after trauma, in rural India. l Method: This was a prospective study conducted on patients with traumatic defects of the leg and foot, admitted between May 2001 and April 2007. Selection of flaps was done on the basis of defect size, site and condition of surrounding tissue. Ipsilateral flaps (proximally- and distally-based), contralateral-leg flaps and free flaps (anterolateral thigh and radial forearm) were raised according to standard techniques and wounds resurfaced accordingly. The outcome was considered ‘excellent’ when there was no flap necrosis and no donor site morbidity, ‘good’ when there was some infection, either at the donor or recipient site, but no necrosis, ‘satisfactory’ when partial flap necrosis and ‘poor’ when there was flap loss. l Results: One-hundred and ten patients (86 males and 24 females) with post-traumatic leg defects underwent reconstruction with different fasciocutaneous flaps.The ages of the patients ranged from 6 years to 58 years, with a mean age of 28.2 ± 11.5 years. Forty cases (37%) underwent immediate reconstruction within the first 72 hours and in 70 cases (63%) delayed reconstruction was done. Hospital stay of the patients ranged from 8 days to 54 days, with a mean of 20.2 ± 1.9 days.There were no complications recorded at donor site.The overall results were considered excellent in 92 cases (84%), good in 12 (11%), satisfactory in four (3.6%) and poor in two cases (1.8%), where flap necrosis occurred. l Conclusion: Our results suggest fasciocutaneous flaps are convenient, simple, reliable and easy to manage. The majority of compound leg defects can be reconstructed with fasciocutaneous flaps either from the ipsilateral leg, contralateral leg or in the form of free flaps. l Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
376
O
pen wounds of the lower extremity most commonly result from trauma due to road traffic accidents,1,2 and may be further complicated by the coexistence of comorbidities, such as diabetes mellitus, hypertension and peripheral vascular diseases. As a result of trauma, patients can end up with compound wounds with exposed bones and tendons, and soft tissue loss. These wounds need reconstruction for many reasons. First, any exposed bone that is not covered by vascularised soft tissue is at risk for osteomyelitis, bone necrosis and sepsis.2 Osteomyelitis is a major cause of amputation in patients following leg trauma, or those with systemic diseases, such as diabetes.3–5 Secondly, open wounds can cause chronic pain, significant medical expenses inability to ambulate or work. Exposed tendons become dry and necrotic and exposed blood vessels are at risk of rupturing. Soft tissue coverage of the lower limb is a formidable challenge and this difficulty is more pronounced in the most distal areas of the leg and foot.6 The
possibilities for coverage of such defects are few; therefore, the flaps chosen should be easy to execute with minimal discomfort to the patient and should provide durable coverage for the defects.7,8 The fasciocutaneous flap was pioneered by Pontén in 1981.9 This flap requires incorporation of deep fascia into the skin flap to gain an improved vascularity. The flaps are simple to raise, quick to execute and have a high reliability. The introduction of fasciocutaneous flaps became a milestone in the management complicated leg defects.10 The goal of lower extremity reconstruction is the coverage of defects and open wounds of the leg to give patients a healed wound and let them resume their life, ambulate and go back to work, while preventing amputation. The aim of this paper is to highlight the role of fasciocutaneous flaps in the management of leg and foot defects, focusing on the repair of defects and wounds sustained after trauma in a modest setup in rural India, where facilities for extensive surgeries, such as microvascular repair, may not be readily available.
© 2013 MA Healthcare
Z. Masoodi,1 MCh(Plast Surg), Resident; I. Ahmad,1 MCh(Plast Surg), Associate Professor; F. Khurram,1 MCh(Plast Surg), Resident; A. Haq,1 MCh(Plast Surg), Resident; 1 Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, India. Email: doctor_ [email protected]
ltd
fasciocutaneous flap; leg defects; free flaps; road traffic accident
j o u r n a l o f wo u n d c a r e v o l 2 2 , n o 7 , J u ly 2 0 1 3
ournal of Wound Care. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights reserved
practice Table 1. Patient and injury demographics No. of patients (n)
110
Male/female (n)
86/24 (78%/22%)
Age (years) l 5–10 l 11–20 l 21–30 l 31–40 l 41–50 l 51–60
5 (4.5%) 24 (22%) 44 (40%) 21 (19%) 11 (10%) 5 (4.5%)
Wound size (cm2)
Management of post road traffic accident compound leg defects using fasciocutaneous flaps l Objective: To highlight the role of fasciocutaneous flaps in the management of leg and foot defects sustained after trauma, in rural India. l Method: This was a prospective study conducted on patients with traumatic defects of the leg and foot, admitted between May 2001 and April 2007. Selection of flaps was done on the basis of defect size, site and condition of surrounding tissue. Ipsilateral flaps (proximally- and distally-based), contralateral-leg flaps and free flaps (anterolateral thigh and radial forearm) were raised according to standard techniques and wounds resurfaced accordingly. The outcome was considered ‘excellent’ when there was no flap necrosis and no donor site morbidity, ‘good’ when there was some infection, either at the donor or recipient site, but no necrosis, ‘satisfactory’ when partial flap necrosis and ‘poor’ when there was flap loss. l Results: One-hundred and ten patients (86 males and 24 females) with post-traumatic leg defects underwent reconstruction with different fasciocutaneous flaps.The ages of the patients ranged from 6 years to 58 years, with a mean age of 28.2 ± 11.5 years. Forty cases (37%) underwent immediate reconstruction within the first 72 hours and in 70 cases (63%) delayed reconstruction was done. Hospital stay of the patients ranged from 8 days to 54 days, with a mean of 20.2 ± 1.9 days.There were no complications recorded at donor site.The overall results were considered excellent in 92 cases (84%), good in 12 (11%), satisfactory in four (3.6%) and poor in two cases (1.8%), where flap necrosis occurred. l Conclusion: Our results suggest fasciocutaneous flaps are convenient, simple, reliable and easy to manage. The majority of compound leg defects can be reconstructed with fasciocutaneous flaps either from the ipsilateral leg, contralateral leg or in the form of free flaps. l Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
376
O
pen wounds of the lower extremity most commonly result from trauma due to road traffic accidents,1,2 and may be further complicated by the coexistence of comorbidities, such as diabetes mellitus, hypertension and peripheral vascular diseases. As a result of trauma, patients can end up with compound wounds with exposed bones and tendons, and soft tissue loss. These wounds need reconstruction for many reasons. First, any exposed bone that is not covered by vascularised soft tissue is at risk for osteomyelitis, bone necrosis and sepsis.2 Osteomyelitis is a major cause of amputation in patients following leg trauma, or those with systemic diseases, such as diabetes.3–5 Secondly, open wounds can cause chronic pain, significant medical expenses inability to ambulate or work. Exposed tendons become dry and necrotic and exposed blood vessels are at risk of rupturing. Soft tissue coverage of the lower limb is a formidable challenge and this difficulty is more pronounced in the most distal areas of the leg and foot.6 The
possibilities for coverage of such defects are few; therefore, the flaps chosen should be easy to execute with minimal discomfort to the patient and should provide durable coverage for the defects.7,8 The fasciocutaneous flap was pioneered by Pontén in 1981.9 This flap requires incorporation of deep fascia into the skin flap to gain an improved vascularity. The flaps are simple to raise, quick to execute and have a high reliability. The introduction of fasciocutaneous flaps became a milestone in the management complicated leg defects.10 The goal of lower extremity reconstruction is the coverage of defects and open wounds of the leg to give patients a healed wound and let them resume their life, ambulate and go back to work, while preventing amputation. The aim of this paper is to highlight the role of fasciocutaneous flaps in the management of leg and foot defects, focusing on the repair of defects and wounds sustained after trauma in a modest setup in rural India, where facilities for extensive surgeries, such as microvascular repair, may not be readily available.
© 2013 MA Healthcare
Z. Masoodi,1 MCh(Plast Surg), Resident; I. Ahmad,1 MCh(Plast Surg), Associate Professor; F. Khurram,1 MCh(Plast Surg), Resident; A. Haq,1 MCh(Plast Surg), Resident; 1 Department of Plastic Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, India. Email: doctor_ [email protected]
ltd
fasciocutaneous flap; leg defects; free flaps; road traffic accident
j o u r n a l o f wo u n d c a r e v o l 2 2 , n o 7 , J u ly 2 0 1 3
ournal of Wound Care. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights reserved
practice Table 1. Patient and injury demographics No. of patients (n)
110
Male/female (n)
86/24 (78%/22%)
Age (years) l 5–10 l 11–20 l 21–30 l 31–40 l 41–50 l 51–60
5 (4.5%) 24 (22%) 44 (40%) 21 (19%) 11 (10%) 5 (4.5%)
Wound size (cm2)
