Distally Based Lateral and Medial Leg Adipofascial Flaps: Need for Caution with Old, Diabetic Patients
Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University, Faculty of Medicine, Ankara, Turkey. Plastic and Reconstructive Surgery
(Impact Factor: 2.99).
02/2006; 117(1):272-6. DOI: 10.1097/01.prs.0000187139.50211.00
Reconstruction of defects around the ankle region has always been challenging for plastic surgeons. Distally based lateral and medial leg adipofascial flaps are among the flaps of choice for coverage of this difficult region. Presented here is the authors' clinical experience with these flaps, particularly emphasizing the complicated attempts in diabetic patients.
Seven skin defects around the ankle were reconstructed with lateral and medial leg adipofascial flaps. The lowermost perforators of the peroneal or posterior tibial artery were identified preoperatively, and a straight incision through skin only was made proximal to this perforator. With the skin flaps reflected, the adipofascial flap was than raised in the subfascial plane. The perforators to be retained in the base were located and the flap was then turned over to cover the defect, followed by application of a split-thickness skin graft over the flap. The donor site was closed primarily.
The ages of the patients ranged from 25 to 80 years, and the size of the flaps ranged from 3 x 5 cm to 7 x 10 cm. Four defects were reconstructed with lateral leg adipofascial flaps, and medial leg adipofascial flaps were used in three. Two flaps healed uneventfully. Partial or total graft loss and partial flap necrosis were observed in five patients, four of whom were diabetic.
Leg adipofascial flaps offer a valuable option for repair of defects around the ankle in many cases. However, adipofascial flaps should be used with caution in old, diabetic patients and, when performed, the probability of a second or third procedure should be considered.
Available from: Tekin Simsek
- "Diabetic ulcers on feet, once established, rarely heal spontaneously and often require flaps to achieve stable coverage. Universal clinical experience has shown that flaps in diabetic patients combined with diabetes-associated microvascular dysfunction, have a high morbidity, and the trend has been to avoid local flaps that require sacrifice of a major artery, or free flaps, in reconstruction of such ulcers  . "
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ABSTRACT: Delayed sural flap based on the vascular axis of the sural nerve has been advocated for coverage of diabetic foot ulcers. In this study we compared the survival of neurovenous and standard inferior epigastric island flaps in diabetic and non-diabetic rats. VEGF concentrations and electrolyte balance of the flaps were also investigated during elevation and on the fifth day to explore the possible mechanisms that influence ischaemia of the flap during the hyperglycaemic state. There were no statistical differences in area surviving between diabetic and control rats for either flap. The VEGF concentrations were also similar in the two flaps in the two groups during elevation. On the fifth day, VEGF concentrations had decreased significantly in all of the flaps. Electrolyte balance paralleled VEGF concentrations. We conclude that flaps based on the vascular axis of a superficial nerve deserve further experimental and clinical attention as potential options for reconstruction of ulcers on diabetic feet.
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