Romul Dhayan Raja, J (2013) Ergonomics of perforator/propellar flaps in lower limb. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Tissue defects in lower limb still present a challenge for the reconstructive Surgeon. Various types of flaps have been used in order to cover them. Perforator/propeller flap represent the latest milestone in the evolution of reconstructive surgery in the armamentarium of local flaps. Local flaps reconstruct the defect with good colour match, texture match, thickness match and also with intact sensation. Since vascular anatomy of perforator vessel has advanced and the availability of microsurgical techniques improved, we have come to recognize the large network of perforator vessels present throughout the body and their potential for flap dissection. This perforator flap are upgraded version of musculocutaneous flaps with complete sparing of muscles and reduced local morbidity and functional disabilities. Even more beneficial and exciting development has been the possibility of using tissue close to or adjacent to the defect as a local perforator/propellar flap. AIM AND OBJECTIVES: 1. To design various flaps based on perforators in the lower limb. 2. To standardize the technique of harvest of perforator/propeller flap. 3. To understand the physiology of blood supply to the newly innovated flap. 4. To ascertain the usefulness of these flaps in planning reconstructive surgery. 5. To improve aesthetic and functional outcome and reducing local morbidity. MATERIALS AND METHODS: The study was conducted in the Dept. of Plastic Reconstructive & Maxillofacial surgery, Rajiv Gandhi Government General Hospital, and Madras Medical College over a period of 18 months from October 2011 to March 2013. Case Studies: All patients with small to large sized soft tissue defects affecting Lower limb except plantar defects were included in the study. The proforma for the collection of data is presented. All the details of the patient, regarding preoperative, surgical, and postoperative and follow up periods were collected and analyzed. Appropriate photographs were taken for documentation. The patients were explained about the nature of the defect and the various flap options available. The proposed procedure was explained to the patient in detail including its merits and demerits. Informed and written consent was obtained from the patient. The proforma was submitted before the Institution Ethical committee and approval obtained. The study did not incur any added expenditure for the patients or the department. Inclusion Criteria: 1. Patients presenting with post traumatic soft tissue defects of lower limb after 72 hours of injury. 2. Sacral and trochantric pressure sore. Exclusion Criteria: 1. Patients with peripheral vascular diseases. 2. Gustilo grade IIIC injuries in lower limb. 3. Advancement, transposition perforator flap and Free style free flap. OBSERVATION & RESULTS: Perforator/propellar flaps for reconstruction of soft tissue defects over the lower limb was done in 40 patients (30 males and 10 females). The age of patients ranged from 20 yrs to 63 yrs. Post traumatic soft tissue defects of Knee, Lower 1/3 leg, Ankle and foot 34 patients, 4 patients were paraplegic with sacral pressure sore and 2patient were paraplegic with trochantric pressure sore. Among 40 patients, 3patients were diabetic, 4 patients had the habit of Smoking. Perforator Characteristics: 1. Average size of perforator was 1.5mm. Average distance between perforator and wound margin was 2cms. CONCLUSION: The perforator/propeller flap in lower limb is a truly versatile flap that is safe, reliable, quick to perform and with standard periperforator dissection, gives a good aesthetic result. The single best perforator contributes to increased influx of blood flow with recruitment of adjacent perforosomes by opening the linking vesssels and larger flap harvest with 95% success rate of flap survival. In our study nearly one third of segment circumference as breadth and one third of segment length as length of flap can be safely recruited on the single best perforator in lower limb .The ability to base a flap on any perforator found in the vicinity of a wound to be reconstructed gives the surgeon unparalleled freedom when designing local flaps.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Ergonomics ; perforator ; propellar flaps ; lower limb |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:42 |
| Last Modified: | 12 Oct 2017 01:42 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3495 |
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