Reconstructive Surgery / Flaps / Grafts


- See:
      - ArteriographyMicroanastomosis, Pharmocological Agents in Vascular Surgery
      - Vaccum Assisted Wound Closure Device

- Discussion:
    - w/ severe extremity wounds, early radical debridement combined with early soft tissue coverage (regional or free flap) will decrease wound infection, flap loss, & delayed bone healing;
    - early coverage will decrease infection, wound desiccation, & necrosis of exposed tendons and bone;
            - note that tendon is the only type of tissue in the extremities that is highly vulnerable to dissecation, and therefore, exposed tendons will not fair well with dressing changes and secondary wound closure;


- Upper Extremity Reconstructive Surgery:
    - hand flaps
    - thumb soft tissue defects


- Lower Extremity Reconstructive Surgery:
    - gastrocnemius flap
    - soleus flap
    - dorsalis pedis fasciocutaneous flap
    - foot reconstuctive surgery
    - references:
          - Preferential Use of the Posterior Approach to Blood Vessels of the Lower Leg in Microvascular Surgery.
          - Peroneal island flap for skin defects in the lower extremity.
          - Acute and definitive management of traumatic osteocutaneous defects of the lower extremity


- Pedicle Flaps
-
STSG
- Free Flaps:
    - free fibular harvest
    - epigastric and rectus abdominis flap
    - latissimus dorsi
    - gracilis
    - dorsalis pedis fasciocutaneous flap
    - dorsalis pedis fasciocutaneous flap
    - lateral arm free flap
    - scapular flap
    - references:
          - Transfer of vascularized grafts of iliac bone to the extremities.
          - Early microsurgical reconstruction of complex trauma of the extremities.        
          - Postoperative course of patients treated with iliac osteocutaneous free flaps. A two- to five-year follow-up study.
          - Ideas and Innovations: Simplified Technique for Isolating Vascularized Rib Periosteal Grafts.
          - The Bipedicled Osteocutaneous Scapula Flap: A New Subscapular System Free Flap.
          - The Segmental Rectus Abdominis Free Flap for Ankle and Foot Reconstruction.
          - An Extended Approach for the Vascular Pedicle of the Lateral Arm Free Flap.
          - Further Experience With the Lateral Arm Free Flap.
          - The Lateral Arm Fascial Free Flap: Its Anatomy and Use in reconstruction.
          - The parascapular flap for treatment of lower extremity disorders.
          - The vascularized cutaneous scapular flap.

Reconstruction of Soft-tissue Injury Associated With Lower Extremity Fracture

 Wound Coverage Techniques for the Injured Extremity




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, August 24, 2012 1:49 pm