Foot Wounds and the Reconstructive Ladder.
Journal
Plastic and reconstructive surgery. Global open
ISSN: 2169-7574
Titre abrégé: Plast Reconstr Surg Glob Open
Pays: United States
ID NLM: 101622231
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
27
08
2021
accepted:
08
10
2021
entrez:
30
12
2021
pubmed:
31
12
2021
medline:
31
12
2021
Statut:
epublish
Résumé
Foot soft tissue coverage represents a challenge to reconstructive surgeons due to a lack of donor sites for this specialized skin. This glabrous tethered thick skin is designed to withstand weight bearing stress and is hard to replace. The limited arch of rotation of foot local flaps contributes to further difficulties. In this study, we share our experience in foot soft tissue loss coverage using techniques tailored to each wound presentation. This case series presents eight patients with wounds of the plantar and dorsal surfaces of the foot, heel, and ankle. Closure techniques were selected and planned based on wound presentation and comorbidity status. Patients' mean age at surgery was 61 years. Etiologies of wounds include trauma, frostbite, diabetic ulceration, malignancy, pressure ulcer with osteomyelitis, and necrotizing infection. Coverage techniques included split and full-thickness skin graft, medial plantar arch pinch graft, cultured epithelial autograft, Hyalomatrix wound device, EpiFix tissue matrix, pedicle flap, and free rectus flap. Complete soft tissue coverage was achieved in each case within reasonable postoperative periods, and ambulation was preserved and/or restored. Foot soft tissue reconstruction is challenging and should be planned carefully due to the required specialized skin replacement. Primary closure should be considered first and attempted if possible. Technique escalation in accordance with the reconstructive ladder should be undertaken based on wound etiology, presentation, amount and nature of tissue loss, available resources, and surgeon experience.
Sections du résumé
BACKGROUND
BACKGROUND
Foot soft tissue coverage represents a challenge to reconstructive surgeons due to a lack of donor sites for this specialized skin. This glabrous tethered thick skin is designed to withstand weight bearing stress and is hard to replace. The limited arch of rotation of foot local flaps contributes to further difficulties. In this study, we share our experience in foot soft tissue loss coverage using techniques tailored to each wound presentation.
METHODS
METHODS
This case series presents eight patients with wounds of the plantar and dorsal surfaces of the foot, heel, and ankle. Closure techniques were selected and planned based on wound presentation and comorbidity status.
RESULTS
RESULTS
Patients' mean age at surgery was 61 years. Etiologies of wounds include trauma, frostbite, diabetic ulceration, malignancy, pressure ulcer with osteomyelitis, and necrotizing infection. Coverage techniques included split and full-thickness skin graft, medial plantar arch pinch graft, cultured epithelial autograft, Hyalomatrix wound device, EpiFix tissue matrix, pedicle flap, and free rectus flap. Complete soft tissue coverage was achieved in each case within reasonable postoperative periods, and ambulation was preserved and/or restored.
CONCLUSIONS
CONCLUSIONS
Foot soft tissue reconstruction is challenging and should be planned carefully due to the required specialized skin replacement. Primary closure should be considered first and attempted if possible. Technique escalation in accordance with the reconstructive ladder should be undertaken based on wound etiology, presentation, amount and nature of tissue loss, available resources, and surgeon experience.
Identifiants
pubmed: 34966631
doi: 10.1097/GOX.0000000000003989
pmc: PMC8710339
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e3989Informations de copyright
Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
Déclaration de conflit d'intérêts
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
Références
J Burn Care Res. 2020 Jul 3;41(4):828-834
pubmed: 32303758
Plast Reconstr Surg. 2001 Sep 15;108(4):885-96
pubmed: 11547143
Plast Reconstr Surg. 2019 Apr;143(4):1223-1244
pubmed: 30921149
Int Wound J. 2016 Apr;13(2):272-82
pubmed: 26695998
J Am Podiatr Med Assoc. 2012 Sep-Oct;102(5):396-405
pubmed: 23001733
Foot Ankle Spec. 2015 Aug;8(4):273-8
pubmed: 25428181
Am J Orthop (Belle Mead NJ). 2006 Jan;35(1):11-9
pubmed: 16475418
Int Wound J. 2018 Feb;15(1):114-122
pubmed: 29024419
Plast Reconstr Surg. 1999 Jul;104(1):175-9
pubmed: 10597691
Clin Dermatol. 2013 Jul-Aug;31(4):413-422
pubmed: 23806158
Ann Plast Surg. 2004 Sep;53(3):256-60
pubmed: 15480013
Acta Orthop Scand Suppl. 1995 Jun;264:27-30
pubmed: 7604725
Burns. 2007 Jun;33(4):405-13
pubmed: 17400392
Int Wound J. 2019 Feb;16(1):19-29
pubmed: 30136445
J Coll Physicians Surg Pak. 2003 Apr;13(4):216-8
pubmed: 12718778
Plast Reconstr Surg. 1979 Sep;64(3):295-8
pubmed: 382204
Int Wound J. 2014 Apr;11(2):159-63
pubmed: 22891615
Cureus. 2020 Aug 19;12(8):e9880
pubmed: 32963919
Diabetes Ther. 2012 Nov;3(1):4
pubmed: 22529027
Foot Ankle Int. 2019 May;40(5):562-567
pubmed: 30688528
Plast Reconstr Surg Glob Open. 2018 Dec 14;6(12):e1991
pubmed: 30656102
J Am Coll Clin Wound Spec. 2018 May 07;9(1-3):1-9
pubmed: 30591894
J Foot Ankle Surg. 2008 Mar-Apr;47(2):145-52
pubmed: 18312922
Eplasty. 2008 Jun 24;8:e33
pubmed: 18650963
Eplasty. 2018 Apr 26;18:e17
pubmed: 29765486
Wounds. 2016 Mar;28(3):78-88
pubmed: 26978861
J Bone Jt Infect. 2019 May 21;4(3):146-154
pubmed: 31192115
J Biomed Mater Res B Appl Biomater. 2016 Oct;104(7):1495-503
pubmed: 26175122
Int Wound J. 2013 Oct;10(5):493-500
pubmed: 23902526