Arterial and Venous Reconstruction for Free Tissue Transfer in Diabetic Ischemic Foot Ulcers
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Keywords:
Peroneal Artery
Popliteal artery
Posterior tibial artery
Foot (prosody)
Cephalic vein
Skin grafting
Abstract Very limited literature described the use of the free anterolateral thigh (ALT) among other flaps for pediatric lower limb reconstruction. The aim of this study is to present our experience using the free ALT flap for reconstruction of soft tissue defects over the dorsum of the foot and ankle in children. The study included 42 children aged 2.5–13 years with a mean of 6.18 years. Three children had crush injuries while the rest were victims of run over car accidents. All of the flaps were vascularized by at least two perforators; 88.23% were musculocutaneous and 11.77 were septocutaneous perforators. All flaps were raised in a subfascial plane. Initial thinning was performed in five flaps and 35% required subsequent debulking. Mean Flap surface area was 117.11 cm 2 . The recipient arteries were the anterior tibial artery in 38 cases and posterior tibial artery in four cases. Venous anastomosis was performed to one vena commitant and in nine cases the long saphenous vein was additionally used. Mean ischemia time of the flap was 2 hours while total operative time averaged 6.3 hours. About 41% of donor sites were closed primarily while 59% required skin grafting. Primary flap survival rate was 92.8% (39/42 cases). Three flaps showed venous congestion. After venous reanastomosis, two flaps showed partial loss and one flap was lost completely. Post‐operative hospital stay averaged 7.5 days. The free ALT flap could be as safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.
Posterior tibial artery
Debulking
Foot (prosody)
Malleolus
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Peroneal Artery
Popliteal artery
Posterior tibial artery
Foot (prosody)
Cephalic vein
Skin grafting
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Cephalic vein
Gangrene
Derivation
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Arteriovenous fistula following use of the balloon catheter for arterial embolectomy has previously been reported between the profunda femoris artery and vein, between the posterior tibial artery and vein, and between the peroneal artery and vein. A case is here described of an arteriovenous fistula between the anterior tibial artery and its venae comitantes at midcalf level.
Anterior tibial artery
Peroneal Artery
Embolectomy
Posterior tibial artery
Balloon catheter
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Free flap reconstruction
Skin grafting
Univariate analysis
Osteoradionecrosis
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Dorsalis pedis artery
Popliteal artery
Anterior tibial artery
Peroneal Artery
Posterior tibial artery
Great saphenous vein
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Background: Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods: This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery.Results: A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions: The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds.
Posterior tibial artery
Peroneal Artery
Skin grafting
Anterior tibial artery
Perforator flaps
Dorsalis pedis artery
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To modify the technique of basilic vein transposition for vascular accesss for haemodialysis aiming at better maturation rate, longer survival of fistula and lesser complications.Case series.Shaikh Zayed Hospital and Omer Hospital, Lahore, from February 2008 to July 2011.Patients referred for basilic vein transposition for haemodialysis vascular access were prospectively enrolled. The surgical technique included small tracking incisions, an extra 3 - 4 cm of vein length harvesting to avoid tension in the vein in its new course, an oval arteriotomy and a smooth curved pathway, away from vein harvesting incision to avoid entrapment of vein in the scar. Maturation rate, fistula survival and other complications were noted.There was no immediate failure in 51 patients. The complications during follow-up period were infection and thrombosis, bleeding and non-development of basilic vein in 2 patients each; and false aneurysm formation in one. Four patients died during follow-up period. The maturation time was 4.9 ± 1.1 weeks. The early patency rate was 92.2%, same at 6 months and 90.7% at 12 months.Arteriovenous fistula constructed with modified technique of basilic vein transposition is an acceptable and valid option of vascular access for haemodialysis.
Basilic Vein
Cephalic vein
Transposition (logic)
Arteriotomy
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Peroneal Artery
Dorsalis pedis artery
Posterior tibial artery
Anterior tibial artery
Popliteal artery
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Incurable ulcer in the lower legs means avascular skin defects exposing bone and osteomyelitis which cannot be repaired even with skin grafting. A total of 151 patients with incurable ulcers were operated with flaps; 60 cases of traumatized avascular defects, 20 diabetic ulcers, 17 osteomyelitis, 14 malignant tumors, 5 arterial obstructions, and 5 arteriovenous malformations, and others. A total of 61 island flaps were used; 20 posterior tibial perforator flaps, 7 saphenous flaps, 7 peroneal flaps, 4 anterior tibial flaps, 4 malleolar perforator flaps, 4 medialis pedis flaps, and others. In addition, a total of 82 free flaps using microvascualr anastomosis were sued; 24 flow‐through anterior thigh flaps, 13 flow‐throuh thoracodorsal artery perforator flaps (or latissimus dorsi MC flap), 8 paraumbilical (or deep inferior epigastric artery ) perforator flap, 6 saphenous venous flaps, 7 combined flaps, and 24 others. In conclusions, small ulcers could be repaired with minimal invasive methods including local perforator flaps and small muscle flaps under local anesthesia. Free flow‐through flaps and free bypass flaps (for diabetic gangrene with ASO), and combined osteocutaneous flaps (for massive segmental defects after resecting advanced carcinoma) are indicated for large ischemic defects.
Perforator flaps
Thoracodorsal artery
Skin grafting
Peroneal Artery
Posterior tibial artery
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