AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Is The Reverse Flow Fasciocutaneous Flaps Appropriate Option For The Reconstruction of Severe Postburn Lower Extremitiy Contractures?
Fatih Uygur, Assistant Professor1, Haluk Duman, Associated Professor2, Ersin Ülkür, Associated Professor3, Bahattin Çeliköz, Professor2, Celalettin Sever, Resident1.
1Gülhane Military Medical Academy Haydarpaşa Training Hospital Plastic surgery and Burn unit, Istanbul, Turkey, 2Gülhane Military Medical Academy Haydarpaşa Training Hospital Plastic Surgery and Burn Unit, Istanbul, Turkey, 3Gülhane Military Medical Academy Haydarpaşa Training HospitalPlastic Surgery and Burn Unit, Istanbul, Turkey.

PURPOSE:
Full thickness burns involving the lower extremity may result in severe contractures which will impair extremity functions, if they are not managed with proper treatment and rehabilitation. After release of postburn contracture of knee, ankle and metatarsopophalangeal joint defects often require coverage by flaps.
In this study, we presents our recent experience with the use of variable reverse flaps options for the reconstruction of soft-tissue defects around different level lower extremities joints after the release of postburn flexion contractures
METHODS: 12 distally based reverse flow flaps were performed for lower-extremity reconstruction after release of postburn flexion contractures. All of the patients were male, their age ranged from 20 to 23 years, with a mean age of 21. After the release of the contractures, three flaps were used based on the location of the contractures. The reverse flow anterolateral thigh flap was used for knee reconstruction (n = 4, 33%). The reverse flow sural flap was used for ankle reconstruction (n = 4, 33%), and the reverse flow medial plantar flap was used for metatarsophalangeal reconstruction (n = 4, 33%). The sizes of the flap varied from 2 to 17 cm width, 3 to 18 cm in length
RESULTS: All 12 flaps survived. All flaps in knee and ankle joint survived completely. Minimal transient venous congestion occured in RALT flaps in early postopetative period. This condition disappeared spontaneously on the postoperative second day with lower extremity elevation. In two flaps in which inset ankle region and MP region, we determined moderate venous congestion. In one case, it was solved by removing the stiches on the flap. Superficial necrosis developed in proximal tip of the one reverse flow sural flap. It was managed minor revision. In one flap, superficial necrosis developed in tip of the reverse medial plantar flaps. It was managed by daily dressing and healed by secondary intention without further complication. Finally all flaps provive stable joint covarage and good contour. Follow-up after surgery ranged from 5 months to 2 year. No reccurrence of contracture had occurred. All flaps remained stable and donor sites healed uneventfully.
CONCLUSION:
In the correction of severe postburn lower extremitiy contractures, the aggressive surgical release results in larger soft tissue defects and suitable coverage is imperative. Reverse fasciocutaneous tissue transfer to reconstruct the soft tissue defects provides early motion, durability for lower extremities. Sufficient contracture lengthening is achieved without displacement of anatomic landmarks. The choose of reverseflow flaps are reasonable option for each joint level in lower extremity.



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