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Our Experience of Proximally Based Sural Artery Flap with Ilizarov Fixator Around The Knee
Keywords:
Complex soft tissue defects, Sural artery, Ilizarov external fixator.Abstract
Objective: To determine the survival of sural artery flap reconstruction of complex soft tissue defects around the knee and use of ilizarov for fixation of proximal tibial fracture.
Methods: This descriptive study was conducted in Orthopedic Department of Sheikh Zayed Medical College/Hospital, Rahim Yar Khan in the period extending from 23rd February 2014 to 23rd June 2019. All the patients fulfilling the inclusion criteria were operated for proximally based sural artery flap to cover the defect and fracture stabilized with Ilizarov fixator. Follow up was for a period of minimum of 06 months for flap survival and up to 1 year for fracture union and knee range of motion.
Results: There were total 17 cases including 14(82.3%) male and 3(17.6%) female with mean age 35±9 years. Road traffic accidents were responsible for majority(64.7%,n=11) of cases while 6(35.2%) had gunshot injuries. The flap sizes ranged from 6x6cm up to 12x cm with pedicel length ranges from 4x10cm.Majority(88.2%,n=15) of flap survived. Proximal tibial fractures united in all patients. Full knee range of motion was documented in all the patients at final follow up.
Conclusion: Proximally based sural artery fasciocutaneous flap with Ilizarov fixator is a reliable method for reconstruction of complex soft tissue defects around the knee. It has good outcome and only few complications.
References
2. Wang TY, Dormans JP, Chang B. Soft-tissue of limb salvage with knee endoprosthesis: The 10-year experience at the children’s Hospital of Philadelphia. Ann Plast Surg 2012;69:560-564.
3. Galat DD, MeGovern SC, Larson DR, Harrington JR, Hanseen AD, Clarke HD. Surgical treatment of early wound complications following primary total knee arthroplasty. J Bone Joing Surg Am 2009;91:48-54.
4. Gillies HD, Millard DR. The Principles and art of plastic Surgery. Boston: Little and Brown; 1957.
5. Laing JH, Hancock K, Harrison DH. The exposed total knee replacement prosthesis: A new classification and treatment algorithm. Br J plast Surg 1992; 45:66-69.
6. Andres LA, Casey WJ, Clarke HD. Techniques in soft tissue Coverage Around the knee. Technique knee Surg 2009;8:119-125.
7. Park S, Eom JS, Selection of the recipient vessel in the free flap around the knee: The superior medial genicular vessels and the descending genicular vessels Plast Reconstr Surg 2001;107:1177-1182.
8. Zheng HP, Lin J, Zhuang YH, Zhang FH. Convenient coverage of soft tissue defects around the knee by the pedicled vastusmedialis perforator flap. J Plast Reconstr Aesthet Surg 2012;65:1151-1157.
9. Hyodo I, Nakayama B, Takahasi M, Toriyama K, Kamei Y, Torii S. The Gastrocnemius with soleus bi-muscle flap. Br J Plast Surg 2004;57:77-82.
10. Fang T, Zhang EW, Lineaweaver WC, Zhang F. Recipient vessels in the free flap reconstruction around the knee. Ann Plast Surg 2013;71:429-433.
11. Tanaka K, Matsumura H, Miyaki T. An anatomic study of the intermuscular septum of the lower leg, branches from the posterior tibial artery and potential for reconstruction of the lower leg and the heal. J Plast Reconstr Aesthet Surg.2006;59:835-838.
12. Nahabedian MY, Orlando JC, Delanois RE, Mont MA, Hungerford DS. Salvage procedure for complex soft tissue defects of the knee. Clin Orthop Relat Res 1998;(356):119-124.
13. Knop W, Buchholz J, Muhr G, Martin D. Negative effects of local tibia muscle flap repair on foot function. Unfallchirug 1993;96:229-234.
14. Venkatramani H, Sabapathy SR, Nayak S. Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle. J Plast Reconstr Aesthet Surg 2014;67:93-98.
15. Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y, Tanaka K et al. Combined arterial reconstruction and free tissue transfer for patient with critical limb ischemia. Ann Vasc Dis 2013;6(4):706-710.
16. Taylor GI. The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 2003;30:215-220.
17. Gravvanis Al, iconomou TG, Panayotou PN, Tsoutsos DA. Medial gastrocnemius muscle flap versus distally based anterolateral thigh flap: Conservative or modern approach to the exposed knee joint. Plast Reconstr Surg 2005;116:932-934.
18. Gravvanis A, Britto JA. Venous augmentation of distall based pedicled ALT flap to reconstruct the tibial tuberosity in a severely injured leg. Ann plast Surg 2009;62:290-292.
19. Opara KO, Nwagbara IC. Reconstruction of complex soft-tissue defects around the knee using the proximally based sural island fasciocutanous flap. Nige Jour clin practice 2019;119:155-254.
20. Cheon SJ, Kim IB, Park WR, Kim HT. The proximally based sural artery flap for coverage of soft tissue defects around the knee and on the proximal thirds and middle third the lower leg. Acta Orthopaedica 2008;79 (3):370-375.
