Motorbike Spoke-Wheel Injuries of the lower limb treated with Fascio-Cutaneous Sural Artery Flap at a Tertiary Care Hospital

Authors

  • Mahesh Kumar Mugria Chairman, Department of Plastic surgery and Burns, Liaquat University of Medical and Health Sciences, Jamshoro
  • Zamir Hussain Tunio Assistant Professor, Department of Orthopedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences, Jasmshoro.
  • Shakeel Ahmed Sheikh Lecturer, Department of Biochemistry, Liaquat University of Medical and Health Sciences, Jasmshoro
  • Nazar Hussain Shah HOD, Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh
  • Shaikh Naeem Ul Haq Assistant Professor Department of Orthopaedic Surgery, Dow International Medical College/Dow University of health sciences, Karachi
  • Muhammad Kashif Abbasi Assistant Professor, Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh.

Keywords:

Faciocutaneous, Flap, motorbike, Spoke-Wheel, Tendo-Achilles, Sural.

Abstract

Objective: To determine the efficacy of reverse fascio-cutaneous sural artery flap in the treatment of heel pad injuries due motorbike spoke-wheel trauma.

Methods: This descriptive study was conducted in Department of Orthopedic Surgery and Department of Plastic Surgery Liaquat University of Medical and Health Sciences, Jamshoro, Sindh from 15th October 2017 to 15th December 2019. All adults patients of either gender and age with motorbike spoke-wheel injuries and heel pad defects fulfilling the inclusion criteria were graded and treated as per Zhu and Li classification with reverse sural artery flap and followed up for flap survival and ankle range of motion.

Results: A total of 15 patients with motorbike spoke-wheel injuries and heel pad defects were included in our study. Male patients were 12(80%) and female were 3 (20%). Mean age of our patients was 24.4±5.1 years(range 18 to 36 years). Right foot was involved in 13 (86.6%) cases whereas 2 (13.3%) patients had left foot injury. Mean duration from injury to flap coverage was 16 ±4 days(range 5 to 20 days).In majority(86.6%,n=13) of our patients reverse sural artery flap survived while in 2(13.3%) patients partial necrosis was noted. Normal ankle range of motion was regained in 14(93.3%) patients while 1(6.6%) had restricted dorsiflexion.

Conclusion: Reverse sural artery flap proved to be a reliable surgical technique for coverage of heel pad wound defects due to motorbike spoke-wheel injuries. We therefore, recommend this flap as a technique of choice to treat heel pad defects due to motorbike spoke-wheel injuries.

References

Sankhala SS, Gupta SP. Spoke-wheel injuries. Indian J Pediatr.1987;54:251-256

Riess J. Verletzungen durch Fahrradspeichen. Klin Med.1948;3:797-800.

Ahmed M. Motorcycle spoke injury. Br Med J.1978;2:401-406.

Lodha SC. Spoke heel injuries in children. Indian J Surg.1973;92-5.

Akhtar S, Hameed A. Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg.2006;59:839-45.

Waikakul S, Vanadurongwan V, Wongtrakul S. Revascularization of subtotal amputation at the ankle in children following motorcycle-spoke injury. Injury.1999;30:51-6.

Zhu YL, Li J, Ma W , Mei LB , Xu YQ. Motorcycle spoke injuries of the heel. Injury, Int. J. Care Injured.2011; 42 :356-361.

Suri MP, Naik NR, Raibagkar SC, Mehta DR. Heel flap injuries in spoke wheel accidents. Injury, Int. J. Care Injured.2007;38:619-624.

De SD, Pho RW: Heel flap injuries in motorcycle accidents. Injury.1983;15:87–92.

Ignatiadis IA, Tsiampa VA , Galanakos SP ,Georgakopoulos GD , Gerostathopoulos NE, Ionac M, et al. The reverse sural fasciocutaneous flap for the treatment of traumatic, infectious or diabetic foot and ankle wounds: A retrospective review of 16 patients. Diabetic Foot & Ankle.2011;2(1):334-340.

Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region. A preliminary report. Scand J Plast Reconstr Surg.1983;17(3):191-6.

Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg.1992;89(6):1115-21.

Foran MP, Schreiber J, Christy MR, Goldberg NH, Silverman RP. The modified reverse sural artery flap lower extremity reconstruction. J Trauma.2008;64:139-143.

Sugg KB, Schaub TA, Concannon MJ, Cederna PS, Brown DL. The reverse superficial sural artery flap revisited for complex lower extremity and foot reconstruction. Plast Reconstr Surg Glob Open.2015;3:519-527.

Tsai J, Liao HT, Wang PF, Chen CT, Lin CH. 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;33:342-3429.

Naumeri F, Qayyum B, Cheema NI, Sohail M, Bashir MM. Motor cycle spoke wheel injuries in children: A preventable accident. Ulus Travma Acil Cerrahi Derg .2019;25:474-478.

Farooq H, Ishtiaq R, Mehr S, Ayub S, Chaudhry UH, Ashraf A, et al. Effectiveness of Reverse Sural Artery Flap in the Management of Wheel Spoke Injuries of the Heel. Cureus.2017; 9(6): 1331-38.

Ali H, Adil F, Idress F. Reverse flow sural flap: A versatile method for the management of soft tissue defects of dorsum of foot, ankle and heel. Professional Med J.2019;26(01):7-13.

Mak C, Chang JHT, Lui TH, Ngai WK. Bicycle and motorcycle wheel spoke injury in children. Journal of Orthopaedic Surgery.2015;23(1):56-8

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Published

2020-10-17

How to Cite

Mahesh Kumar Mugria, Zamir Hussain Tunio, Shakeel Ahmed Sheikh, Nazar Hussain Shah, Shaikh Naeem Ul Haq, & Muhammad Kashif Abbasi. (2020). Motorbike Spoke-Wheel Injuries of the lower limb treated with Fascio-Cutaneous Sural Artery Flap at a Tertiary Care Hospital. Journal of Pakistan Orthopaedic Association, 32(03), 115–120. Retrieved from http://jpoa.org.pk/index.php/upload/article/view/444

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