Lower limb reconstruction involving osteosynthesis material: A retrospective study on propeller flaps outcomes. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Guillier, D; Sapino, G; Schaffer, C; Borens, O; Thein, E; Bramhall, RJ; di Summa, PG
• Is Part Of: Injury. Volume 52:Issue 10(2021)
• Page Start: 3117
• Page End: 3123
• Publication Date: 2021-10
• Subjects: Lower limb -- Propeller perforator flap -- Bone fracture -- Soft tissue defect; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.04.003
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: The need for a stable and reliable coverage Is particularly high in soft tissue defects of lower limb particularly when orthopedic underlying metalwork is in place. Propeller flaps are a useful and reliable tool in lower limb reconstruction. If contaminated metalwork has to replacement, a further debridement is compulsory, and a larger soft tissue flap cover (such as free flaps) is usually the best choice. The importance of careful case selection for considering perforator-based propellor flaps in lower limb reconstruction such as no metalwork exposure. Abstract: Introduction: Reconstruction of soft tissue defects in lower limb fractures requiring internal fixation remains a challenging scenario with the optimal surgical treatment still debated. This study aims to recommend, and eventually redefine, surgical indications for propeller flaps reconstruction in the distal lower limb, with a particular focus on the presence or not of metalwork. Methods: A retrospective study of lower limb soft tissue reconstructions performed between January 2015 and July 2018 was carried out including all patients treated with a propeller perforator flap (PPF) with at least 6-month follow-up. Patients were further divided in 2 groups depending on the presence of metalwork fixation beneath the flap (F group, propeller on Framework; NF group, propeller with No-Framework). Results: 21 patients were retained (F group, 11 patients; NF group, 10 patients). There were no significant differences between the two groups in age, BMI, ASA scores, comorbidities or defect size. There was a statistically significant difference between the groups (p<0.05) in the cumulative hospital stay with a mean cumulative hospital stay of 22 ± 9 days in the F group and 12 ± 8 days in NF group. Failures were higher where PPF were used to cover hardware material, with 3 patients requiring a major secondary procedure in F group versus 1 patient in NF group. Conclusion: The presence of underlying metalwork significantly reduced the margin for small, day-case revision procedures such as flap readvancement or STSG. This study emphasizes clinical intuition that whilst PPF are a useful and elegant tool in lower limb reconstruction, their use should be limited when underlying metalwork is present.