Pedicled Flaps for Coverage of Soft-tissue Defects in Children
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Abstract
Introduction: The aim of this study is to evaluate the results achieved using pedicle flaps for coverage of soft-tissue defects in children.Material and Methods: Thirteen children who suffered trauma or burn of the extremities, with soft-tissue loss or severe retraction, requiring a pedicled flap for adequate coverage, treated between 2004 and 2013, were retrospectively evaluated. Patient’s age averaged 7.9 years .Time between initial trauma and flap coverage averaged 39 days. Coverage was achieved using a sural flap in four cases, a neurovascular island flap (Littler) in two cases, a radial forearm flap in two cases, a groin flap three cases, an abdominal flap in one case and a latissimus dorsi flap in one case. In all cases associated lesions were repaired or reconstructed at the same surgical procedure.Results: Follow-up averaged 19 months. Adequate coverage was achieved in all 13 cases. In 13 cases we obtained good coverage of the defect. Hospitalization time averaged 8.1 days. One patient developed infection, one flap had superficial necrosis and two patients developed hypertrophic scars. Two patients needed extensor tendon tenolisis and two needed z-plasties. All patients who had lower limb defects returned to sports with no limitations.Conclusion: Despite the growing number of free flaps being described, pedicled flaps allow adequate coverage in most soft-tissues defects in children; since they allow good coverage of bone, tendons and neurovascular structures; being possible to simultaneously reconstruct all associated injuries. The disadvantages of using these flaps in adults is immobilization of the affected limb, with potential stiffness and edema formation, but this was not evident in the children included in this series.
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How to Cite
Nuñez, J. E., Bertolotti, R., Iglesias, S., Flores, G., Vanoli, F., & Allende, C. (2016). Pedicled Flaps for Coverage of Soft-tissue Defects in Children. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(1), 20-26. https://doi.org/10.15417/518
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Clinical Research
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References
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2. Cierni IIIG, Byrd HS, Jones RE. Primary versus dalayed softtissue coverage for severe open tibia fractures: a comparison of results. Clin Orthop 1983; 178:54-63.
3. Zancolli EA, Angrigiani C, Posterior interosseous island forearm flap. J Hand Surg (Br) 1988; 13:130-135.
4. Buchler U, Frey HP. Retrograde posterior interosseous flap. J Hand Surg (Am) 1991; 16:283-292.
5. Foucher G, van Genechten F, Merle M, et al. A compound radial artery foream flap in hand surgery: an original modification of the Chinese forearm flap. Br J Plast Surg 1984; 37:139-148.
6. Soutar DS, Tanner NSB. The radial forearm flap in the management of soft tissue injuries of the hand. Br J Plast Surg 1984; 37:18-26.
7. Soutar DS, Scheker LR, Tanner NSB, et al. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36:1-8.
8. Timmons MJ. The vascular basis of the radial forearm flap. Plast Reconstr Surg 1986; 77:80-92.
9. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992;89:1115-21.
10. Allende C, Fattor E, Valdez D, Diaz P, Bagliardelli J. Reconstrucciones complejas post traumaticas de los tejidos blandos. Principios de tratamientos y resultados. Rev Asoc Arg Ortop y Traumatol. 2009; 74:122-133.
11. Daniel A, Medalie MD. Perforator- Based forearm and hand adipofascial flaps for the coverage of difficult dorsal hand wounds. Annals of Plastic Surgery.2003; 50: 104.
12. Iglesias S, Allende C, Gutiérrez N, Núñez J, Ruchelli L. Colgajo fasciocutaneo Sural Inverso para Cobertura de defectos de partes blandas en pierna, tobillo y pie. Rev Asoc Arg Ortop y Traumatol. 2014;79 (4): 204-209.
13. Rotella JM. Cirugía reparadora del pulgar. Colgajo cutáneo con pedículo neurovascular reinervado. Rev Asoc Arg Ortop Traumatol. 1986; 51:169-74.
14. Fattor E, Bagliardelli J, Valdez D, Cata E y Allende C. Amputaciones traumáticas del pulgar. Tratamiento primario, principios y resultados. Rev. Asoc. Argent. Ortop. Traumatol. 2010;75 (4): 341-350.
15. Yasar S, Lin CH, Wei FC. One stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg. 2004; 114(6): 1457-1466.
16-Bellidenty L, Chastel R, Pluvy I, Pauchot J, Tropet Y. Emergency free flap inreconstrution of the lower limb. Thrity-five years of experience. Ann Chir Plast Esthet. 2014; 59(1): 35-41.
17. Ong YS, Levin LS. Lower Limb Salvage in Trauma. Plast Reconstrution Surg 2010; 125(2):582-588.
18. Poitevin L. Vascularización de la extremidad distal de los dedos de la mano. Rev Asoc Arg Ortop y Traumatol 1986;51:307-15.
19. Blondeel PN, Van Landuyt KH, Monstrey SJ, Hamdi M, Matton GE, Allen RJ, y col.. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003;112:1378-83.
20. Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator based propeller flaps for lower extremity reconstruction? July 2014; 472: 2276-2286
21. Inoue Y, Taylor GI. The angiosomes of the forearm: Anatomic Study and Clinical application. Plast Reconstr Surg 1996; 98:195-210.
22. Koshima I, Moriguchi T, Etoh H, et al. The Radial Artery Perforator-Based Adipofascial Flap for dorsal hand coverage. Ann Plast Surg 1995; 35:474-479.
23. Goertz O1, Kapalschinski N, Daigeler A, Hirsch T, Homann HH, Steinstraesser L, Lehnhardt M, Steinau HU. The effectiveness of pedicled groin flaps in the treatment of hand defects: results of 49 patients. J Hand Surg Am. 2012;37(10):2088-94.
24. Arner M, Moller K. Morbidity of the pedicled groin flap. A retrospective study of 44 cases. Scand J Plast Reconstr Surg Hand Surg 1994; 28: 143-146.
25. Wood MB, Irons GB. Upper- extremity free skin flap transfer: results and utility as compared with conventional distant pedicle skin flaps. Ann Plast Surg 1983; 11:523-526.
26. Esezobor EE, Nwokike OC, Aranmolate S, Onuminya JE, Abikoye FO. Sural nerve preservation in reverse sural artery fasciocutaneous flap: a case report. Ann Surg Innov Res 2012; 6:10.
27. Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast reconstr Surg 1998 ; 102: 779-791.
28. Nakajima H, Imanshi N, Fukuzumi S, et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plas Rec Surg. 1999; 103(1):104-120.
2. Cierni IIIG, Byrd HS, Jones RE. Primary versus dalayed softtissue coverage for severe open tibia fractures: a comparison of results. Clin Orthop 1983; 178:54-63.
3. Zancolli EA, Angrigiani C, Posterior interosseous island forearm flap. J Hand Surg (Br) 1988; 13:130-135.
4. Buchler U, Frey HP. Retrograde posterior interosseous flap. J Hand Surg (Am) 1991; 16:283-292.
5. Foucher G, van Genechten F, Merle M, et al. A compound radial artery foream flap in hand surgery: an original modification of the Chinese forearm flap. Br J Plast Surg 1984; 37:139-148.
6. Soutar DS, Tanner NSB. The radial forearm flap in the management of soft tissue injuries of the hand. Br J Plast Surg 1984; 37:18-26.
7. Soutar DS, Scheker LR, Tanner NSB, et al. The radial forearm flap: a versatile method for intra-oral reconstruction. Br J Plast Surg 1983; 36:1-8.
8. Timmons MJ. The vascular basis of the radial forearm flap. Plast Reconstr Surg 1986; 77:80-92.
9. Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 1992;89:1115-21.
10. Allende C, Fattor E, Valdez D, Diaz P, Bagliardelli J. Reconstrucciones complejas post traumaticas de los tejidos blandos. Principios de tratamientos y resultados. Rev Asoc Arg Ortop y Traumatol. 2009; 74:122-133.
11. Daniel A, Medalie MD. Perforator- Based forearm and hand adipofascial flaps for the coverage of difficult dorsal hand wounds. Annals of Plastic Surgery.2003; 50: 104.
12. Iglesias S, Allende C, Gutiérrez N, Núñez J, Ruchelli L. Colgajo fasciocutaneo Sural Inverso para Cobertura de defectos de partes blandas en pierna, tobillo y pie. Rev Asoc Arg Ortop y Traumatol. 2014;79 (4): 204-209.
13. Rotella JM. Cirugía reparadora del pulgar. Colgajo cutáneo con pedículo neurovascular reinervado. Rev Asoc Arg Ortop Traumatol. 1986; 51:169-74.
14. Fattor E, Bagliardelli J, Valdez D, Cata E y Allende C. Amputaciones traumáticas del pulgar. Tratamiento primario, principios y resultados. Rev. Asoc. Argent. Ortop. Traumatol. 2010;75 (4): 341-350.
15. Yasar S, Lin CH, Wei FC. One stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg. 2004; 114(6): 1457-1466.
16-Bellidenty L, Chastel R, Pluvy I, Pauchot J, Tropet Y. Emergency free flap inreconstrution of the lower limb. Thrity-five years of experience. Ann Chir Plast Esthet. 2014; 59(1): 35-41.
17. Ong YS, Levin LS. Lower Limb Salvage in Trauma. Plast Reconstrution Surg 2010; 125(2):582-588.
18. Poitevin L. Vascularización de la extremidad distal de los dedos de la mano. Rev Asoc Arg Ortop y Traumatol 1986;51:307-15.
19. Blondeel PN, Van Landuyt KH, Monstrey SJ, Hamdi M, Matton GE, Allen RJ, y col.. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003;112:1378-83.
20. Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator based propeller flaps for lower extremity reconstruction? July 2014; 472: 2276-2286
21. Inoue Y, Taylor GI. The angiosomes of the forearm: Anatomic Study and Clinical application. Plast Reconstr Surg 1996; 98:195-210.
22. Koshima I, Moriguchi T, Etoh H, et al. The Radial Artery Perforator-Based Adipofascial Flap for dorsal hand coverage. Ann Plast Surg 1995; 35:474-479.
23. Goertz O1, Kapalschinski N, Daigeler A, Hirsch T, Homann HH, Steinstraesser L, Lehnhardt M, Steinau HU. The effectiveness of pedicled groin flaps in the treatment of hand defects: results of 49 patients. J Hand Surg Am. 2012;37(10):2088-94.
24. Arner M, Moller K. Morbidity of the pedicled groin flap. A retrospective study of 44 cases. Scand J Plast Reconstr Surg Hand Surg 1994; 28: 143-146.
25. Wood MB, Irons GB. Upper- extremity free skin flap transfer: results and utility as compared with conventional distant pedicle skin flaps. Ann Plast Surg 1983; 11:523-526.
26. Esezobor EE, Nwokike OC, Aranmolate S, Onuminya JE, Abikoye FO. Sural nerve preservation in reverse sural artery fasciocutaneous flap: a case report. Ann Surg Innov Res 2012; 6:10.
27. Nakajima H, Imanishi N, Fukuzumi S, et al. Accompanying arteries of the cutaneous veins and cutaneous nerves in the extremities: anatomical study and a concept of the venoadipofascial and/or neuroadipofascial pedicled fasciocutaneous flap. Plast reconstr Surg 1998 ; 102: 779-791.
28. Nakajima H, Imanshi N, Fukuzumi S, et al. Accompanying arteries of the lesser saphenous vein and sural nerve: anatomic study and its clinical applications. Plas Rec Surg. 1999; 103(1):104-120.