Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients

2021 ◽  
Author(s):  
Eleanor S. Lumley ◽  
Jin Geun Kwon ◽  
Beatriz Hatsue Kushida-Conteras ◽  
Erin Brown ◽  
Julian Viste ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Diabetic Patients ◽  
Flap Reconstruction ◽  
Limb Salvage Rate ◽  
Free Flap Reconstruction ◽  
Flap Survival ◽  
Transmetatarsal Amputation ◽  
Salvage Rate

Abstract Background Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. Methods Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type. Results Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9–20 days). Patients were followed-up for a median of 344 days (range: 142–594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type. Conclusion TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.

scholarly journals Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity

2016 ◽  
Vol 02 (01) ◽  
pp. e7-e14
Author(s):  
Sören Könneker ◽  
G.F. Broelsch ◽  
J.W. Kuhbier ◽  
T. Framke ◽  
N. Neubert ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Statistical Significance ◽  
Group Versus ◽  
Outcome Analysis ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Flap Survival ◽  
Anastomotic Technique ◽  
End To End

Background End-to-end and end-to-side anastomoses remain the most common techniques in microsurgical free flap reconstruction. Still, there is an ongoing effort to optimize established techniques and develop novel techniques. Numerous comparative studies have investigated flow dynamics and patency rates of microvascular anastomoses and their impact on flap survival. In contrast, few studies have investigated whether the type of anastomosis influences the outcome of microvascular free flap reconstruction of a lower extremity. Patients and Methods Retrospectively, we investigated the outcome of 131 consecutive free flaps for lower extremity reconstruction related to the anastomotic technique. Results No statistical significance between arterial or venous anastomoses were found regarding the anastomotic techniques (p = 0.5470). However, evaluated separately by vessel type, a trend toward statistical significance for anastomotic technique was observed in the arterial (p = 0.0690) and venous (p = 0.1700) vessels. No thromboses were found in arterial end-to-end anastomoses and venous end-to-side anastomoses. More venous (n = 18) than arterial thromboses (n = 9) occurred in primary anastomoses undergoing microsurgical free flap reconstruction (p = 0.0098). Flap survival rate was 97.37% in the end-to-end arterial group versus 86.36% in the end-to-side group. No thromboses were found in five arterial anastomoses using T-patch technique. Conclusion For lower extremities, there is a connate higher risk for venous thrombosis in anastomotic regions compared with arterial thrombosis. We observed divergent rates for thromboses between end-to-end and end-to-side anastomoses.However, if thrombotic events are explained by anastomotic technique and vessel type, the latter carries more importance.

scholarly journals Use of the Anterolateral Thigh in Cranio-Orbitofacial Reconstruction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
William J. Parkes ◽  
Howard Krein ◽  
Ryan Heffelfinger ◽  
Joseph Curry
Keyword(s):  
Free Flap ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Tissue Loss ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Anterolateral Thigh ◽  
The Many ◽  
Soft Tissue Loss

Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita and highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients who underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed. Data reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length of stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected cases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51 free flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications included 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and effective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the extent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the many cranio-orbitofacial defects encountered.

Implantable Venous Doppler Monitoring in Head and Neck Free Flap Reconstruction Increases the Salvage Rate

2010 ◽  
Vol 125 (4) ◽  
pp. 1129-1134 ◽  
Author(s):  
Keyianoosh Z. Paydar ◽  
Scott L. Hansen ◽  
David S. Chang ◽  
William Y. Hoffman ◽  
Pablo Leon
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
Salvage Rate

Free-Flap Reconstruction for Diabetic Lower Extremity Limb Salvage

2020 ◽  
Vol 248 ◽  
pp. 165-170
Author(s):  
Z-Hye Lee ◽  
David A. Daar ◽  
John T. Stranix ◽  
Lavinia Anzai ◽  
Jamie P. Levine ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Limb Salvage ◽  
Free Flap ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

Free flap reconstruction for diabetic foot limb salvage

2017 ◽  
Vol 51 (6) ◽  
pp. 399-404 ◽  
Author(s):  
Tomoya Sato ◽  
Yuichiro Yana ◽  
Shigeru Ichioka
Keyword(s):  
Limb Salvage ◽  
Free Flap ◽  
Diabetic Foot ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction

S110 – Free Tissue Transfer Reconstruction of Fistula after ACDF

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P114-P114
Author(s):  
Sarah R. Rossmiller ◽  
Tamer Ghanem ◽  
Mark K Wax
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Fistula Formation ◽  
Flap Reconstruction ◽  
Esophageal Diverticulum ◽  
Free Flap Reconstruction ◽  
Incision And Drainage ◽  
Tissue Transfer ◽  
Radial Forearm

Objectives Pharyngeal injury post-anterior cervical disc fusion (ACDF) repair is a well-recognized postoperative complication. It can lead to abscess formation, pharyngocutaneous fistula, and esophageal diverticulum. Various reconstructive procedures have been proposed, including primary repair or pedicled muscle flaps. In recalcitant cases, free tissue transfer can be used. We review our experience with patients undergoing free tissue transfer for repair of pharyngeal defects. Methods Retrospective data review from January 2002 to February 2008 of patients undergoing pharyngeal repair following ACDF surgery. Results 5 patients were identified for total of 6 reconstruction procedures. Presentation of the pharyngeal leak occurred from 8 days to 3 years after the ACDF procedure. 3 patients presented acutely with cervical abscesses requiring incision and drainage. 2 patients underwent hardware removal at the time of incision and drainage. 2 patients presented with dysphagia and a contained esophageal diverticulum. 4 of the patients underwent radial forearm fasciocutaneous free flap reconstruction, and 1 underwent anterolateral thigh musculocutaneous free flap reconstruction. One patient had a revision surgery for recurrent fistula formation after radial forearm free flap with rectus free flap reconstruction. There were no immediate postoperative leaks; however, on 1–51 months follow-up, 4 out of 6 cases developed a diverticulum, with one of them developing a second fistula. 3 out of 5 patients had no evidence of diverticulum or fistula at last follow-up, for a success rate of 60%. Conclusions Pharyngo-esophageal perforation following an ACDF approach is difficult to repair even with free tissue transfer.

Improving limb salvage rate in diabetic patients with critical leg ischaemia using a multidisciplinary approach

2009 ◽  
Vol 63 (6) ◽  
pp. 855-858 ◽  
Author(s):  
H. Zayed ◽  
M. Halawa ◽  
L. Maillardet ◽  
P.S. Sidhu ◽  
M. Edmonds ◽  
...  
Keyword(s):  
Limb Salvage ◽  
Multidisciplinary Approach ◽  
Diabetic Patients ◽  
Limb Salvage Rate ◽  
Salvage Rate

scholarly journals Free Tissue Transfer Optimizes Stump Length and Functionality Following High-Energy Trauma

2019 ◽  
Vol 04 (02) ◽  
pp. e96-e101
Author(s):  
Merisa L. Piper ◽  
Dominic Amara ◽  
Sarosh N. Zafar ◽  
Charles Lee ◽  
Hani Sbitany ◽  
...  
Keyword(s):  
Lower Extremity ◽  
San Francisco ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
High Energy ◽  
Limb Length ◽  
Flap Reconstruction ◽  
Free Flap Reconstruction ◽  
High Energy Trauma ◽  
Tissue Transfer

Abstract Background Advances in medicine and surgery have allowed patients, who in the past would have required more aggressive amputations, to maintain longer stump lengths. Microvascular free tissue transfer has become increasingly popular to preserve limb length and optimize functionality. We present our experience using microvascular free flap reconstruction to preserve lower extremity limb length in the setting of high-energy trauma. Methods We conducted an Institutional Review Board-approved retrospective review of patients at three San Francisco hospitals who underwent free flap reconstruction after high-energy trauma between 2003 and 2015. We included all patients who underwent free flap reconstruction for lower extremity limb length preservation. We reviewed patient demographics, preoperative variables, intraoperative details, and postoperative outcomes, including complications, functional status, reoperation rates, and need for revision amputation. Results Twelve patients underwent microvascular free tissue transfer for limb length preservation. Overall, the patients had similar preoperative comorbidities and a mean age of 44. Six patients had postoperative complications: three minor complications and three major complications. Seven patients had additional surgeries to improve the contour of the flap. One patient required revision amputation, while the remaining 11 patients preserved their original limb length. The majority of patients were fully ambulatory, and four used a prosthesis. Conclusion Microvascular free tissue transfer can be used to effectively maintain lower extremity stump length following trauma. Although these patients often require multiple surgeries and face lengthy hospital courses, this technique enables preservation of a functional extremity that would otherwise require a more proximal amputation.

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