Restoration of Distal Third Leg and Heel Soft Tissue Defects Using Local Muscle Flaps | ||||
| The Egyptian Journal of Plastic and Reconstructive Surgery | ||||
| Article 13, Volume 42, Issue 1, January 2018, Page 85-92 PDF (17.36 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejprs.2018.215069 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Osama Al Shahat  ; Magdy Abdel Mooktader; Mahmoud Nasef
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| The Department of Plastic and Burn Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt | ||||
| Abstract | ||||
| Background: Wound coverage of exposed lower third tibia and ankle region remains a difficult task. Muscle flaps are preferred for infected wounds especially where there are exposed bone, joint and/or tendons. Patients and Methods: This study includes 60 patients with soft tissue defects at the distal third of leg. The study duration was from April 2014 to April 2016. Cases in this study were classified into two groups. Flap selection was random. Group (A) include 30 patients reconstructed by distally based peroneus brevis muscle flap. Group (B) include 30 patients reconstructed by distally based medial hemisoleus muscle. Routine investigations included full laboratory investigations and plain X-rays. Patients were operated under regional or general anesthesia. Flap was assessed daily and first dressing was done on day five of surgery. Patients were discharged once flap and split skin grafting were healthy on assessment after first dressing and subsequent dressings. Patients were followed up twice weekly for the first month and then once a month for six months. Results: Group (A): Mean age 41 year, 29 cases male and one case female. Site of the soft tissue defect: 14 case at the lateral malleolus, 2 cases at the medial malleolus, 9 cases for exposed tendoachillies, 4 cases at the anterior part of the ankle joint and one case at the peritibial part of the distal third leg. Size of the defect width rang from 3cm to 10cm and length rang from 3cm to 12cm. Splitting of the muscle was done for 7 patients to increase its width and 23 case non splitting. Complications: Only flap necrosis in one case need other procedure for reconstruction and complete successful in 29 case. Group (B): Mean age 41 year, 28 case male and 2 cases female. Site of the defect: 16 case at the medial malleolus and 14 cases at the peritibial part of distal third leg. Size of the defect width rang from 3cm to 7cm and length from 3cm to 10cm. Complication: Flap failure occurred in 11 case and complete successful in 19 cases. Conclusion: Local muscle flaps is areliable method for reconstruction of soft tissue defects at the distal third of the leg. | ||||
| Keywords | ||||
| Distal third leg; Peronus brevis; Hemisoleus; Muscle flap | ||||
| References | ||||
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Klebuc M. and Menn Z.: Muscle flaps and their role in limb salvage. Methodist DeBakey Cardiovascular Journal, 9 (2): 95, 2013. 2- Verhelle N., Vranckx J., Van den Hof B. and Heymans O.: Bone exposure in the leg. Plastic and Reconstructive Surgery, 116 (1): 170-177, 2005. 3- Chen S.L., Chen T.M., Chou T.D., Chang S.C. and Wang H.J.: Distally based sural fasciomusculocutaneous flap for chronic calcaneal osteomyelitis in diabetic patients. Annals of Plastic Surgery, 54 (1): 44-48, 2005. 4- Erdmann D., Gottlieb N., Humphrey J.S., Le T.C., Bruno W. and Levin L.S.: Sural flap delay procedure: A preliminary report. Annals of Plastic Surgery, 54 (5): 562-565, 2005. 5- Tosun Z., Özkan A., Karaçor Z. and Savaci N.: Delaying the reverse sural flap provides predictable results for complicated wounds in diabetic foot. Annals of Plastic Surgery, 55 (2): 169-173, 2005. 6- Abd-Al Moktader M.A.: Open-book splitting of a Distally Based Peroneus Brevis Muscle Flap to Cover Large Leg and Ankle Defects. Plastic and Reconstructive Surgery, 3 (12), 2015. 92 Vol. 42, No. 1 / Restoration of Distal Third Leg & Heel Soft Tissue Defects 7- Alain C., Masquet and Paulo S.: Soleus flap. Flap and Reconstructive Surgery, 1 (31): 423-438, 2013. 8- Attinger C.E., Ducic I., Cooper P. and Zelen C.M.: The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and non diabetic patients. Plastic and Reconstructive Surgery, 110 (4): 1047-54, 2002. 9- Taylor I.G. and Pan W.R.: Angiosomes of the leg: Anatomic study and clinical implications. Plastic and Reconstructive Surgery, 102 (3): 599-616, 1998. 10- Yang Y.L., Lin T.M., Lee S.S., Chang K.P. and Lai C.S.: The distally pedicled peroneus brevis muscle flap anatomic studies and clinical applications. The Journal of Foot and Ankle Surgery, 44 (4): 259-264, 2005. 11- Ensat F., Hladik M., Larcher L., Mattiassich G. and Wechselberger G.: The distally based peroneus brevis muscle flap-clinical series and review of the literature. Microsurgery, 34 (3): 203-208, 2014. 12- Hallock G.G.: Getting the most from the soleus muscle. Annals of Plastic Surgery, 36 (2): 139-146, 1996. 13- Raveendran S.S. and Kumaragama K.G.J.L.: Arterial supply of the soleus muscle: Anatomical study of fifty lower limbs. Clinical Anatomy, 16 (3): 248-252, 2003. 14- Pu L.L.: The reversed medial hemisoleus muscle flap and its role in reconstruction of an open tibial wound in the lower third of the leg. Annals of plastic Surgery, 56 (1): 59-64, 2006. 15- Eren S., Ghofrani A. and Reifenrath M.: The distally pedicled peroneus brevis muscle flap: A new flap for the lower leg. Plastic and Reconstructive Surgery, 107 (6): 1443-1448, 2001. 16- Bajantri B., Bharathi R., Ramkumar S., Latheef L., Dhane S. and Sabapathy S.R.: Experience with peroneus brevis muscle flaps for reconstruction of distal leg and ankle defects. Indian journal of plastic surgery: Official publication of the Association of Plastic Surgeons of India, 46 (1): 48, 2013. | ||||
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