PDF(Pubmed)
Abstract：
BACKGROUND: The efficacy and safety of perforator-based propeller flaps (PPF) versus free flaps (FF) in traumatic lower leg and foot reconstructions are debated. PPFs are perceived as simpler due to advantages like avoiding microsurgery, but concerns about complications, such as flap congestion and necrosis, persist. This study aimed to compare outcomes of PPF and FF in trauma-related distal lower extremity soft tissue reconstruction.
METHODS: We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis.
RESULTS: The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases.
CONCLUSIONS: Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction.
UNASSIGNED: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
METHODS: We retrospectively studied 38 flaps in 33 patients who underwent lower leg and foot soft tissue reconstruction due to trauma at our hospital from 2015 until 2022. Flap-related outcomes and complications were compared between the PPF group (18 flaps in 15 patients) and the FF group (20 flaps in 18 patients). These included complete and partial flap necrosis, venous congestion, delayed osteomyelitis, and the coverage failure rate, defined as the need for secondary flaps due to flap necrosis.
RESULTS: The coverage failure rate was 22% in the PPF group and 5% in the FF group, with complete necrosis observed in 11% of the PPF group and 5% of the FF group, and partial necrosis in 39% of the PPF group and 10% of the FF group, indicating no significant difference between the two groups. However, venous congestion was significantly higher in 72% of the PPF group compared to 10% of the FF group. Four PPFs and one FF required FF reconstruction due to implant/fracture exposure from necrosis. Additionally, four PPFs developed delayed osteomyelitis post-healing, requiring reconstruction using free vascularized bone graft in three out of four cases.
CONCLUSIONS: Flap necrosis in traumatic lower-leg defects can lead to reconstructive failure, exposing implants or fractures and potentially causing catastrophic outcomes like osteomyelitis, jeopardizing limb salvage. Surgeons should be cautious about deeming PPFs as straightforward and microsurgery-free procedures, given the increased complication rates compared to FFs in traumatic reconstruction.
UNASSIGNED: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
摘要：
背景：基于穿孔器的螺旋桨皮瓣（PPF）与游离皮瓣（FF）在创伤性小腿和足部重建中的有效性和安全性存在争议。由于避免显微外科手术等优点，PPF被认为更简单，但是担心并发症，如皮瓣充血和坏死，坚持。这项研究旨在比较PPF和FF在创伤相关的下肢远端软组织重建中的效果。
方法：我们回顾性研究了2015年至2022年在我院因外伤而接受小腿和足部软组织重建的33例患者的38个皮瓣。比较PPF组（15例患者中有18个皮瓣）和FF组（18例患者中有20个皮瓣）之间皮瓣相关的结果和并发症。这些包括完全和部分皮瓣坏死，静脉充血,迟发性骨髓炎,和覆盖故障率，定义为由于皮瓣坏死而需要二次皮瓣。
结果：PPF组的覆盖失败率为22％，FF组为5％，在11%的PPF组和5%的FF组中观察到完全坏死，和部分坏死在39%的PPF组和10%的FF组，表明两组之间没有显着差异。然而,与FF组的10%相比,PPF组的72%的静脉充血显著高于FF组的10%.由于来自坏死的植入物/骨折暴露,四个PPF和一个FF需要FF重建。此外,四个PPF在愈合后发展为迟发性骨髓炎，在四分之三的病例中，需要使用游离血管化骨移植物进行重建。
结论：外伤性小腿缺损的皮瓣坏死可导致重建失败，暴露植入物或骨折，并可能导致灾难性的结果，如骨髓炎，危及肢体抢救。外科医生应该谨慎地将PPFs视为简单且无需显微外科手术的程序，考虑到创伤重建中与FF相比，并发症发生率增加。
■在当前研究过程中生成和/或分析的数据集可根据相应的作者的合理要求获得。
方法：我们回顾性研究了2015年至2022年在我院因外伤而接受小腿和足部软组织重建的33例患者的38个皮瓣。比较PPF组（15例患者中有18个皮瓣）和FF组（18例患者中有20个皮瓣）之间皮瓣相关的结果和并发症。这些包括完全和部分皮瓣坏死，静脉充血,迟发性骨髓炎,和覆盖故障率，定义为由于皮瓣坏死而需要二次皮瓣。
结果：PPF组的覆盖失败率为22％，FF组为5％，在11%的PPF组和5%的FF组中观察到完全坏死，和部分坏死在39%的PPF组和10%的FF组，表明两组之间没有显着差异。然而,与FF组的10%相比,PPF组的72%的静脉充血显著高于FF组的10%.由于来自坏死的植入物/骨折暴露,四个PPF和一个FF需要FF重建。此外,四个PPF在愈合后发展为迟发性骨髓炎，在四分之三的病例中，需要使用游离血管化骨移植物进行重建。
结论：外伤性小腿缺损的皮瓣坏死可导致重建失败，暴露植入物或骨折，并可能导致灾难性的结果，如骨髓炎，危及肢体抢救。外科医生应该谨慎地将PPFs视为简单且无需显微外科手术的程序，考虑到创伤重建中与FF相比，并发症发生率增加。
■在当前研究过程中生成和/或分析的数据集可根据相应的作者的合理要求获得。
