Valarmathy, V S (2013) A clinical study of various methods of foot defect reconstruction with respect to dorsum of foot ankle and its outcome. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Foot re-construction poses a particular challenge to the plastic surgeon. The aim of foot reconstruction to give us adequate soft tissue cover and maintaining functional recovery Defects of Foot & Ankle with exposed tendon & bone require either local & free flap coverage. With a good understanding of anatomy regarding Dorsum of foot and ankle the availability of pedicled and free flaps provides a durable coverage for the foot defects. Surgical techniques to reconstruct the foot can be differentiated by five main criteria 1. Local Fasio Cutaneous Flaps, 2. Distally based superficial sural artery flaps, 3. Distally based lateral Supramalleolar artery based flaps. 4. Perforator based Propellar flaps. 5. Microvascular free flaps; a) Anterolateral Thigh Flap, b) Lattisimus Dorsi Muscle Flap. To select the suitable method of reconstruction factors like defect size involvement of surrounding structures, and morbidity of the surgical procedures should be considered for all the cases and functional and aesthetic aspects. AIMS & OBJECTIVE : Primary Objective : To analyze the foot defects and discuss the various established reconstructive options available and their application Secondary Objective(s) : To evaluate the functional outcomes of various surgical procedures following dorsum of foot and ankle defects. MATERIALS AND METHODS : The study was conducted in department of plastic reconstructive, Maxillofacial Surgery, Madras Medical College and Rajiv Gandhi Govt. General Hospital, Chennai during the period of August 2010 to February 2013. Thirty patients were examined and analysed based on the established reconstructive options and operated in emergency or elective settings. Pre-operatively assessment included a thorough history and physical examination. Time and mechanism of injury, age, occupational status and general health of the patients are the factors considered before surgery. The foot and the Ankle were assessed with regard to vascular status with degree of contamination and severity of soft tissue loss. Skeletal assessments were done with x-ray of the foot and ankle. The degree of communition,bone loss and intra articular damage were studied. Basic blood investigations were done. Informed written concerns were obtained from all patients. Prophylatic antibiotics were given to all patients. RESULTS: Of the 30 cases operated, trauma was the major cause of injury followed by infection. In traumatic, RTA was the major cause followed by work spot injuries. Most of the injuries in the Dorsum of the foot were associated with exposure of tendons and bones which required flap cover. Due to the severity of the injuries local flaps were unavailable for reconstruction and distant flaps were utilized for the same. Loco Regional Flaps were used in 9 cases in which peroneal artery perforator flap in 3 cases, anteriortibial artery perforator flap in 4 cases and arcuate artery perforator flap in 1 case. 2 Cases were operated with micro vascular free flap since the defects were large in which loco regional flap were not adequate. Distant pedicle flaps in which 4 cases showed distal tip necrosis, 3 cases of reverse sural flap and one case of lateral supramalleolar flap, the raw area healed with secondary intention. 2 Cases of perforator flaps showed congestion but the flap survived. Skin graft loss was found in 4% of cases grafted, post-operatively physiotherapy was started once the graft and flap settled well. Follow up of the patients was done for 3 to 6 months and functional assessment of the foot was done with ankle and toe movements. Aesthetic results were analysed by texture and color match. Correction of contour deformities and donor site morbidity. Color and texture match was better with loco regional flap than distant flaps. CONCLUSION The tissue on the dorsum of foot is thin, mobile and nonglabrous to allow movements of the joints of the foot. The thin layer of areolar tissue covering the tendons permits smooth tendon gliding. Reconstruction should aim at all the structural component of foot. The surgeon should analyze the efficiency and outline correct reconstructive plan. Local skin flaps has color match, texture match and thickness match, should be considered if the defect is relatively small. Perforator flap should be considered as second option for smaller defects of the dorsum and ankle since these perforator flaps have 98 % success rate is related to hyperperfusion of this flaps. Hyper perfusion and increased blood flow exists in the perforator flaps as whole pressure head of source vessel is directed in to single best perforator. Reduction of steal phenomena by other tissues like muscle and fascia and the flap combines the benefit of increased blood flow of musculocutaneous system minus the muscle. The SBP is chosen by size, visible and palpable pulsatile nature and this also contributes to increased flow and larger flap harvest .98% success rate by ready recruitment of more perforosomes opening the linking vessels Morbidity of donor site is almost nil.Source vessel with prominent cutaneous nerve, muscle and fascia are maintained at donor site. Most of the donor areas are closed primarily. Aesthetic reconstruction- no dog ears, contour deformities Systemic morbidity also minimal Because it is microsurgical technique minus the microsuturing, blood loss is minimal. Our average operating time is 1 1/2 hours. Loupe magnification is used in all cases.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | clinical study ; various methods ; foot defect reconstruction ; dorsum of foot ankle ; outcome. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 01:46 |
| Last Modified: | 12 Oct 2017 01:46 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3498 |
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