Distally based fasciocutaneous flaps: a versatile option for coverage of difficult war wounds of the foot and ankle.
Early reconstructive treatment of war-related lower extremity injuries can be feasible even when evacuation to ideal tertiary facilities is impossible. However, in such instances, lengthy procedures considered "state of the art" in the everyday civilian practice of plastic surgery are often impractical, and alternative options need to be sought. Undelayed distally based fasciocutaneous flaps of the leg have recently been used in 12 cases of extensive defects of the foot due to antipersonnel mine injuries. All patients, treated during the conflict in Bosnia-Herzegovina, were smokers and were between 17 and 45 years of age. No preoperative arteriography or Doppler was available. One flap was totally lost, and two others suffered tip necrosis. All other cases healed uneventfully. We were impressed at the reliability of distally based fasciocutaneous flaps, even with length-to-width ratios of up to 5:1, and even after distal deepithelialization or tubing of the pedicle. The whole foot can be reached when the appropriate lateral or medial based flap is selected. Obvious disadvantages are the grafted secondary defect of the leg and the lack of sensation, although the latter is a common feature shared by most other flaps to the foot. Also, free-muscle transfer is preferable for very deep defects with extensive bone loss. However, for the ease of dissection, versatility, and short operating time, distally based fasciocutaneous flaps find a definite place in reconstructive trauma surgery.
Robotti
E
E
Department of Plastic Surgery of the Ospedali Riuniti, Bergamo, Italy.
Verna
G
G
Fraccalvieri
M
M
Bocchiotti
M A
MA
D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D016512:Ankle Injuries / Q000601:surgery*; D001753:Blast Injuries / Q000601:surgery*; D017522:Bosnia and Herzegovina; D018409:Foot Injuries / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D014857:Warfare