Vallarta RRA, López RJL

Language: Spanish
References: 15
Page: 146-151
PDF size: 408.72 Kb.

ABSTRACT

There is a wide range of options for reconstruction of lower extremity defects. The technique that provides better functional and aesthetic results with the least risk should be chosen. The big challenge for the surgeon is to select the most appropriate method that suits the patient’s individual needs. We present the case of a 49- year- old woman with a history of bilateral knee arthroplasty and development of lower limb deep vein thrombosis and pulmonary embolism. Four months after the orthopedic procedure, we performed an evaluation and found a 7 x 5 cm defect in the upper third of the right leg with tibial exposure, bone sequestration and soft tissue infection. The patient´s comorbidities and history of embolism contraindicated muscle flaps and free tissue transfer. Surgical management was made in several stages including the advance of previously delayed bipedicled fasciocutaneous flaps with random circulation previously delayed. Adequate coverage with acceptable cosmetic results was obtained, without the need of large or distant donor sites. The short duration of the procedures decreased the likelihood of recurrence of a thromboembolic event.

REFERENCES

1. Mathes SJ, Scott LH. Flap classification and applications. In: Mathes SJ, Hentz VR, Ed: Plastic surgery. Volume I. 2nd ed. Philadelphia: Elsevier 2006; pp. 367-368, 415-416, 454.

2. Feng LJ, Price DC, Mathes SJ, Hohn D. Dynamic properties of blood flow and leukocyte mobilization in infected flaps. World J Surg 1990; 14(6): 796-803.

3. Stelnicki EJ, Young VL, Francel T, Randall P. Vilray P. Blair, his surgical descendants, and their roles in plastic surgical development. Plast Reconstr Surg 1999; 103: 1990-2009.

4. Milton SH. The effects of “delay” on the survival of experimental pedicled skin flaps. Br J Plast Surg 1969; 22: 244-252.

5. Guba AM Jr. Study of the delay phenomenon in axial pattern flaps in pigs. Plast Reconstr Surg 1979; 63: 550-554.

6. DeFranzo AJ, Argenta LC, Marks MW et al. The use of vacuum-assisted closure therapy for the treatment of lower extremity wounds with exposed bone. Plast Reconstr Surg 2001; 108: 1184-1191.

7. Argenta LC, Morykwas MJ, Marks MW, DeFranzo AJ, Molnar JA, David LR. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg 2006; 117 (7 Suppl.): 127S-142S.

8. Mackenzie DJ, Seyfer AE. Reconstructive surgery: lower extremity coverage. In: Mathes SJ, Hentz VR, Ed. Plastic surgery. Volume VI. 2nd ed. Philadelphia: Elsevier 2006; pp 1369-1374.

9. Beahm EK, Walton RL, Lohman RF. Vascular insufficiency of the lower extremity: lymphatic, venous, and arterial. In: Mathes SJ, Hentz VR, Ed. Plastic surgery. Volume VI. 2nd ed. Philadelphia: Elsevier 2006; pp. 1465-1466.

10. Swartz WM, Ramasastry SS, McGill JR, Noonan JD. Distally based Vastus lateralis muscle flap for coverage of wounds about the knee. Plast Reconstr Surg 1987; 80: 255-265.

11. Reddy V, Stevenson TR. MOC-PS (SM) CME article: lower extremity reconstruction. Plast Reconstr Surg 2008; 121: 1-7.

12. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg 2011; 66: 388-392.

13. Geerts WH, Heit JA, Clagett GP et al. Prevention of venous thromboembolism. Chest 2001; 119(1 Suppl): 132S-175S.

14. Heit JA, Silverstein MD, Mohr DN et al. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160(6): 809-815.

15. Wei FC, Suominen S. Principles and techniques of microvascular surgery. In: Mathes SJ, Hentz VR, Ed. Plastic surgery. Volume I. 2nd ed. Philadelphia: Elsevier 2006; pp. 525.