Hyperbaric oxygen therapy and surgical delay improve fap survival of reverse pedicle faps for lower third leg and foot reconstruction

Abstract

Aim: The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps, by including hyperbaric oxygen (HBO) therapy in the treatment regimen with flap delay.

Methods: We present a prospective study of 23 patients with various types of soft tissue defects of the foot, and lower third of leg managed in our institution from December 2012 to December 2013. All soft tissue defects were treated by a reverse pedicle flap. Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy. The postoperative period, hospital course, and follow-up were documented.

Results: Of 12 patients with flap delay and HBO, 10 patients did not suffer any complications secondary to flap transfer. One patient had discoloration of the tip of the flap, which settled without the intervention, and 1 patient had recurrent abscess formation, which required debridement and closure. Of 11 patients with direct transfer, 6 patients presented with complications including flap congestion, partial flap loss, and tip necrosis, which required secondary intervention.

Conclusion: HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.

Keywords

Flap delay / hyperbaric oxygen therapy / reverse pedicle flap / soft tissue reconstruction

References

[1] Demiri E,Dionyssiou D,Kakas P,Lazaridis L.Our experience with the lateral supramalleolar island flap for reconstruction of the distal leg and foot: a review of 20 cases..Scand J Plast Reconstr Surg Hand Surg2006;40:106-10

[2] Voche P,Stussi JD.The lateral supramalleolar flap: experience with 41 flaps..Ann Plast Surg2005;54:49-54

[3] Almeida MF,Okawa RY.Reverse-flow island sural flap..Plast Reconstr Surg2002;109:583-91

[4] Kneser U,Polykandriotis E,Horch RE.Delayed reverse sural flap for staged reconstruction of the foot and lower leg..Plast Reconstr Surg2005;116:1910-7

[5] Mehrotra S.Perforator plus flaps: optimizing results while preserving function and esthesis..Indian J Plast Surg2010;43:141-8 PMCID:PMC3010772

[6] Zayed EF.Lateral supramalleolar flap for reconstruction of the distal leg and foot, clinical experience with 25 cases..Egypt J Plast Reconstr Surg2011;35:279-86

[7] Ulkür E,Ergun O,Yildiz S.The effect of hyperbaric oxygen therapy on the delay procedure..Plast Reconstr Surg2007;119:86-94

[8] Bhutani S.Hyperbaric oxygen and wound healing..Indian J Plast Surg2012;45:316-24 PMCID:PMC3495382

[9] Kemmer A.Crush injury and other traumatic ischemia..In: Mathieu D, editor. Handbook on Hyperbaric Medicine.2006;NetherlandsSpringer311-2

[10] Baumeister SP,Erdmann D,Levin LS.A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group..Plast Reconstr Surg2003;112:129-40

[11] Kang HG,Cho HS,Oh JH.Soft tissue reconstruction of the foot using the distally based island pedicle flap after resection of malignant melanoma..Clin Orthop Surg2010;2:244-9 PMCID:PMC2981782