Reconstruction of soft tissue defects using transposition loco-regional perforator island flaps

Abstract

Introduction Treatment of chronic non-healing wounds in the presence of deep post-traumatic soft tissue defects is a challenge for trauma reconstruction. The objective of the study was to improve healthcare quality for patients with chronic soft tissue defects of the limb. The goals included evaluation of the effectiveness of reconstruction of defects of the lower limb using local transposition perforant flaps, and rationale for a preferred choice for the keystone perforator flap. Material and methods The review included 48 patients with post-traumatic and osteomyelitic soft tissue defects of lower limbs. Patients were divided into 2 groups. Patients of the study group were treated with regional perforator fasciocutaneous flaps combined with osteonecrectomy that could be also performed later (n = 22). In the comparison group (n = 26), post-traumatic and osteomyelitic defects were treated with conventional methods of local wound treatment, staged osteonecrectomies followed by autodermoplasty. Results The use of the transposition loco-regional perforator flaps resulted in the incidence of secondary necrosis reduced by 33.7% and the two-fold reduction in the average number of staged operations. One-stage reconstruction was performed in 72.7 % patients of the study group. The length of inpatient treatment decreased by an average of 30 bed days. Discussion The reduced length of treatment in the study group could be caused by the absence or a significantly reduced stage of local wound treatment; there were fewer complications in the form of secondary necrosis of deep-lying tissues that would require additional treatment stages. Conclusions Reconstruction of osteomyelitic defects with the transposition of loco-regional perforant flaps allowed lower complication rate and improved functional outcomes for patients with posttraumatic and osteomyelitic defects of soft tissues of lower limbs.

Keywords

• soft tissues of limb
• defect
• post-traumatic
• osteomyelitic
• perforant island flaps
• chronic osteomyelitis
• chronic non-healing wound