Current principles and trends of using axial pattern flaps in reconstructive surgery of the extremities

Cover Page


Cite item

Full Text

Abstract

On the basis of published data, we identified and analyzed current principles and trends of using axial pattern tissue complexes in patients with limb defects, depending on the nature and localization of the defect, and also objectives of reconstructive surgery. Today, there are three closely related trends. The most important one is to reduce injury caused by intervention; this results in using non-free island flaps instead of the widespread use of free perfused tissue complexes. The second trend is aimed at obtaining the most favorable functional results in treating defects of the covering structures relative to similar defects of bones and muscle-tendon units. The third trend is minimizing the negative aesthetic results.

About the authors

D. I. Kutyanov

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: kutianov@rambler.ru
Россия

L. A. Rodomanova

Vreden Russian Research Institut of Traumatology and Ortopedics; Nort-Western State Medical University

Email: afar_kav@mail.ru
Россия

References

  1. Борзунов Д.Ю., Макушин В.Д., Чевардин А.Ю. Несвободная костная пластика по Илизарову в проблеме возмещения гетерогенных дефектов длинных костей. Гений ортопедии. 2006; (4):43-46.
  2. Делиникайтис С.В., Островский Н.В. Пластика травматических дефектов кожи конечностей. В кн.: Лечение сочетанных травм и заболеваний конечностей. М.; 2003. с. 95-97.
  3. Кочиш А.Ю., Родоманова Л.А., Полькин А.Г., Валетова С.В., Козлов И.В. Возможности пластики осевыми кожными лоскутами в области крупных суставов нижней конечности. Анналы пластической, реконструктивной и эстетической хирургии. 2005; (3):72-73.
  4. Кутянов Д.И. Использование технологий реконструктивно-пластической микрохирургии в системе лечения больных с патологией крупных суставов и околосуставных структур конечностей: дис. д-ра мед. наук. СПб.: РНИИТО им. Р.Р. Вредена; 2014. 386 с.
  5. Миланов Н.О., Шилов Б.Л., Шибаев Е.Ю. Возможности использования васкуляризированной фасции в реконструктивной хирургии. Анналы пластической, реконструктивной и эстетической хирургии. 1997;(1):33-39.
  6. Родоманова Л.А. Возможности реконструктивной микрохирургии в раннем лечении больных с обширными посттравматическими дефектами конечностей: дис. д-ра мед. наук. СПб.: рНиИТО им. Р.Р. Вредена; 2010. 375 с.
  7. Родоманова Л.А., Полькин А.Г. Реконструктивная микрохирургия верхней конечности. Травматология и ортопедия России. 2006; (4):15-19.
  8. Тихилов Р.М., Кочиш А.Ю., Родоманова Л.А., Разоренов В.Л., Козлов И.В. Современные тенденции пластики лоскутами с осевым типом кровоснабжения на нижней конечности. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2007; (2):71-75.
  9. Шибаев Е.Ю., Иванов П.А., Кисель Д.А., Неведров А.В. Закрытие дефектов мягких тканей при тяжелых открытых переломах костей голени. Политравма. 2012; (1):21-31.
  10. Arai K., Toh S., Tsubo K., Nishikawa S., Narita S., Miura H. Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg. 2002; 109(7):2301-2306.
  11. Bannasch H., Haivas I., Momeni A., Stark G.B. Oncosurgical and reconstructive concepts in the treatment of soft tissue sarcomas: a retrospective analysis. Arch Orthop Trauma Surg. 2009; 129:43-49.
  12. Barner-Rasmussen I., Popov P., Böhling T., Blomqvist C., Tukiainen E. Microvascular reconstructions after extensive soft tissue sarcoma resections in the upper limb. Eur J Surg Oncol. 2010; 36:78-83.
  13. Barner-Rasmussen I., Popov P., Böhling T., Tarkkanen M., Sampo M., Tukiainen E. Microvascular reconstruction after resection of soft tissue sarcoma of the leg. Br J Surg. 2009; 96:482-489.
  14. Capanna R., Campanacci D.A., Belot N., Beltrami G., Manfrini M., Innocenti M., Ceruso M. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. Orthop Clin North Am. 2007; 38:51-60.
  15. Chaput B., Gandolfi S., Ho Quoc C., Chavoin J.P., Garrido I., Grolleau J.L. Reconstruction of cubital fossa skin necrosis with radial collateral artery perforator-based propeller flap (RCAP). Ann Chir Plast Esthet. 2014; 59(1):65-69.
  16. Chuang D.C. Nerve transfer with functioning free muscle transplantation. Hand Clin. 2008; 24(4):377-388.
  17. Colen L.B., Pessa J.E., Potparic Z., Reus W.F. Reconstruction of the extremity with the dorsal thoracic fascia free flap. Plast Reconstr Surg. 1998;101(3):738-744.
  18. Courvoisier A., Sailhan F., Mary P., Damsin J.P. Case reports: lengthening of a vascularized free fibular graft. Clin Orthop Relat Res. 2009; 467(5):1377-1384.
  19. Demirtas Y., Kelahmetoglu O., Cifci M., Tayfur V., Demir A., Guneren E. Comparison of free anterolateral thigh flaps and free muscle-musculocutaneous flaps in soft tissue reconstruction of lower extremity. Microsurgery. 2010; 30:24-31.
  20. El-Gammal T.A., El-Sayed A., Kotb M.M. Telescoping vascularized fibular graft: a new method for treatment of congenital tibial pseudarthrosis with severe shortening. J Pediatr Orthop B. 2004; 13(1):48-56.
  21. Friedrich J.B., Moran S.L., Bishop A.T., Wood C.M., Shin A.Y. Free vascularized fibular graft salvage of complications of long-bone allograft after tumor reconstruction. J Bone Joint Surg Am. 2008; 90(1):93-100.
  22. Grinsell D., Di Bella C., Choong P.F. Functional reconstruction of sarcoma defects utilising innervated free flaps. Sarcoma. 2012;2012:315190. doi: 10.1155/2012/315190.
  23. Hallock G.G. A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps. J Reconstr Microsurg. 2013; 29(4):233-240.
  24. Han C.S., Chung D.W., Lee J.H., Jeong B.O. Lengthening of intercalary allograft combined with free vascularized fibular graft after reconstruction in pediatric osteosarcoma of femur. J Pediatr Orthop B. 2010;19(1):61-65.
  25. Hattori Y., Doi K., Pagsaligan J.M., Takka S., Ikeda K. Arthroplasty of the elbow joint using vascularized iliac bone graft for reconstruction of massive bone defect of the distal humerus. J Reconstr Microsurg. 2005; 21(5):287-291.
  26. Hazani R., Brooks D., Buntic R.F. Resurfacing of a complex upper extremity injury: an excellent indication for the dorsal thoracic fascial flap. Microsurgery. 2009; 29(2):128-232.
  27. Ilizarov S., Blyakher A., Rozbruch S.R. Lengthening of a free fibular graft after sarcoma resection of the humerus. Clin Orthop Relat Res. 2007; 457:242-246.
  28. Kim J.Y., Subramanian V., Yousef A., Rogers B.A., Robb G.L., Chang D.W. Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma. Plast Reconstr Surg. 2004; 114:400-410.
  29. Kim K.S., Kim E.S., Kim D.Y., Lee S.Y., Cho B.H. Resurfacing of a totally degloved hand using thin perforator-based cutaneous free flaps. Ann. Plast. Surg. 2003; 50:77-81.
  30. Leblebicioglu G. Reliability of vascularized fibula in maintaining arthrodesis following extra-articular wide excisions of malignant musculoskeletal tumors. Saudi MedJ. 2006; 27(8):1204-1211.
  31. Li J., Wang Z., Guo Z., Chen G.J., Li S.W., Pei G.X. The use of massive allograft with intramedullary fibular graft for intercalary reconstruction after resection of tibial malignancy. J Reconstr Microsurg. 2011; 27(1):37-46.
  32. Lin C.H., Lin Y.T., Yeh J.T., Chen C.T. Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect. Plast Reconstr Surg. 2007; 119(7):2118-2126.
  33. Lin C.H., Zhu Z.S., Lin C.H., Hsu C.C., Yeh J.T., Lin Y.T. Primary free functioning muscle transfer for fingers with accompanying tendon transfer for thumb provide one-stage upper extremity composite reconstruction in acute open wound. J Trauma Acute Care Surg. 2012; 72(3):737-743.
  34. Lin S.H., Chuang D.C., Hattori Y., Chen H.C. Traumatic major muscle loss in the upper extremity: Reconstruction using functioning free muscle transplantation. J Reconstr Microsurg. 2004; 20(3):227-235.
  35. Lu L., Liu A., Zhu L., Zhang J., Zhu X., Jiang H. Crossleg flaps: Our preferred alternative to free flaps in the treatment of complex traumatic lower extremity wounds. J Am Coll Surg. 2013; 217:461-471.
  36. Maciel-Miranda A., Morris S.F., Hallock G.G. Local flaps, including pedicled perforator flaps: anatomy, technique, and applications. Plast Reconstr Surg. 2013; 131(6):896e-911e.
  37. Marek C.A., Pu L.L. Refinements of free tissue transfer for optimal outcome in lower extremity reconstruction. Ann Plast Surg. 2004; 52(3):270-275.
  38. Mastorakos D.P., Disa J.J., Athanasian E., Boland P., Healey J.H., Cordeiro P.G. Soft-tissue flap coverage maximizes limb salvage after allograft bone extremity reconstruction. Plast Reconstr Surg. 2002; 109:1567-1573.
  39. Misra A., Mistry N., Grimer R., Peart F. The management of soft tissue sarcoma. J Plast Reconstr Aesthet Surg. 2009;62:161-174.
  40. Misra A., Niranjan N.S. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg. 2005; 115(6):1625-1632.
  41. Momeni A., Kalash Z., Stark G.B., Bannasch H. The use of the anterolateral thigh flap for microsurgical reconstruction of distal extremities after oncosurgical resection of soft-tissue sarcomas. J Plast Reconstr Aesthet Surg. 2011; 64:643-648.
  42. Moscatiello F., Masià J., Carrera A., Clavero J.A., Larranaga J.R., Pons G. The “propeller” distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthet Surg. 2007; 60(12):1323-1330.
  43. Mottard S., Grimer R.J., Abudu A., Carter S.R., Tillman R.M., Jeys L., Spooner D. Biological reconstruction after excision, irradiation and reimplantation of diaphyseal tibial tumours using an ipsilateral vascularised fibular graft. J Bone Joint Surg Br. 2012; 94(9):1282-1287.
  44. Muramatsu K., Ihara K., Hashimoto T., Seto S., Taguchi T. Combined use of free vascularised bone graft and extracorporeally-irradiated autograft for the reconstruction of massive bone defects after resection of malignant tumor. J Plast Reconstr Aesthet Surg. 2007; 60(9):1013-1018.
  45. Muramatsu K., Ihara K., Taguchi T. Selection of myocutaneous flaps for reconstruction following oncologic resection of sarcoma. Ann Plast Surg. 2010; 64:307-310.
  46. Nayak B.B., Mohanty N. Muscle conserving free gracilis transfer (mini-gracilis free flap). Indian J Plast Surg. 2012; 45(1):130-133.
  47. Papaioannou K., Lallos S., Mavrogenis A., Vasiliadis E., Savvidou O., Efstathopoulos N. Unilateral or bilateral V-Y fasciocutaneous flaps for the coverage of soft tissue defects following total knee arthroplasty. J Orthop Surg Res. 2010; 5:82.
  48. Parodi P.C., De Biasio F., Rampino Cordaro E., Guarneri G.F., Panizzo N., Riberti C. Distally-based superficial sural flap: advantages of the adipofascial over the fasciocutaneous flap. Scand J Plast Reconstr Surg Hand Surg. 2010; 44(1):37-43.
  49. Pederson W.C., Person D.W. Long bone reconstruction with vascularized bone grafts. Orthop Clin North Am. 2007; 38(1):23-35.
  50. Schmidt K., Jakubietz M., Djalek S., Harenberg P.S., Zeplin P.H., Jakubietz R. The distally based adipofascial sural artery flap: faster, safer, and easier? A long-term comparison of the fasciocutaneous and adipofascial method in a multimorbid patient population. Plast Reconstr Surg. 2012; 130(2):360-368.
  51. Seal A., Stevanovic M. Free functional muscle transfer for the upper extremity. Clin Plast Surg. 2011; 38(4):561-575.
  52. Sugiura H., Takahashi M., Nakanishi K., Nishida Y., Kamei Y. Pasteurized intercalary autogenous bone graft combined with vascularized fibula. Clin Orthop Relat Res. 2007; 456:196-202.
  53. Taniguchi Y., Kitano T., Shimoe T., Asai Y., Yoshida M. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg. 2009; 25:479-482.
  54. Terzis J.K., Barmpitsioti A. Secondary shoulder reconstruction in patients with brachial plexus injuries. J Plast Reconstr Aesthet Surg. 2011; 64(7):843-853.
  55. Tsai J., Liao H.T., Wang P.F., Chen C.T., Lin C.H. Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: Patient selection and surgical refinement. Microsurgery. 2013; 33(5):342-349.
  56. Tu Y.K., Yen C.Y., Ma C.H., Yu S.W., Chou Y.C., Lee M.S., Ueng S.W. Soft-tissue injury management and flap reconstruction for mangled lower extremities. Injury. 2008; 39, Suppl. 4:75-95.
  57. Vranckx J.J., Misselyn D., Fabre G., Verhelle N., Heymans O., Van den hof B. The gracilis free muscle flap is more than just a «graceful» flap for lower-leg reconstruction. J Reconstr Microsurg. 2004; 20:143-148.
  58. Wiedner M., Koch H., Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg. 2011; 66:388-392.
  59. Yazar S., Lin C.H., Lin Y.T., Ulusal A.E., Wei F.C. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg. 2006; 117:2468-2477.
  60. Zhen P., Hu Y.Y., Luo Z.J., Liu X.Y., Lu H., Li X.S. One-stage treatment and reconstruction of Gustilo Type III open tibial shaft fractures with a vascularized fibular osteoseptocutaneous flap graft. J Orthop Trauma. 2010; 24(12):745-751.
  61. Zuker R.M., Manktelow R.T. Functioning free muscle transfers. Hand Clin. 2007; 23(1):57-72.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2015


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies