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Island flaps in the treatment of the lower limb’s tissue defects


Author: Verega Grigore
Degree:doctor habilitat of medicine
Speciality: 14.00.22 - Orthopedics and Traumatology
Year:2010
Scientific consultant: Filip Gornea
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"
Scientific council: DH 50-14.00.22-27.03.08
State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 16 December, 2009
Approved by NCAA on the 11 February, 2010

Abstract

Adobe PDF document0.80 Mb / in romanian

Keywords

lower limb, defects, island flaps.

Summary

Thesis structure: introduction, eight chapters, completion, conclusion, practical recommendations, bibliography from 277 scientific sources, annexes -3 , basic text pages - 212 , figures - 166 , 21 – tables. Obtained results are published in 66 scientific works. Key words: lower limb, defects, island flaps.

The study represents the surgical treatment of the lower limb’s posttraumatic tissue defects . The study goal is elaborating of contemporary concept of the island flaps’ raising and their large use in order to improve the results in surgical treatment of the patients who have tissue defects at the level of the lower limb. Into achieving this goal, the following exploration objectives have been established: 1 - Studying the potential donor of each segment of the lower limb for raising vascularized flaps; 2 - Reasoning the migration techniques of the lower limb’s island flaps in dependence of the defect’s location and migration directions; 3 - Studying the migration limits of each flap and forming the map of territorial coverage of migrated flaps on the lower limb’s segments; 4 - Elaborating contemporary surgical treatment algorithm of the lower limb’s defects by using the island flaps; 5 - Determining the indications and the contraindications in the treatment with island flaps of the lower limb’s posttraumatic tegumentary defects; 6 - Improving the existent surgical techniques and elaborating new island flaps migration methods to the lower limb; 7 - Elaborating prevention and treatment methods of vascular complications in transferred flaps; 8 - Studying at distance the functional adaptation processes of migrated island flaps in the treatment of the lower limb’s defects. Research Methodology. Initially was defined the lower limb’s and opportunities for hedging their with vascular flaps. The patients included in the study were evaluated up to treatment, observed during treatment and at a distance of 12 to 18 months after finishing, presenting a prospective and randomized study. Statistical evaluation and scientific analysis served as scientific argument for the cognitive strategies to study further the possibilities of covering the defects with island flap plastic by developing new methods and improving treatment by dividing the bulk of results depending on the direction of migration. Innovative scientific element: - On the basis of anatomic research there were elaborated and used: buttock flap migrated on a fascio-cellular pedicle, supramalleolar flap migrated on a vascular pedicle from peroneal vessels communications with anterior tibial vessels (and medial plantar flap on the basis of superficial medial plantar vessels. - It was proposed and realized a tibiotalar arthrodesis with vascularized bone fragment from fibula for avascular diseases and septic talocrural arthritis but the healthy part of tissues from amputated segment stump was used under the form of flap for stump coverage . - Indications and contraindications were established for plasty with different flaps in concrete regions of the lower limb, as well as surgical techniques for treatment. It was elaborated a series of prophylaxis and treatment measures of postoperative vascular complications in case of the lower limb’s island flaps. - The flaps classification was completed with a new term alternative island flaps .Also were elaborated: postoperative sensitive adaptation coefficient (Psac), utility coefficient of flap (Uc), absolute morbidity coefficient (Amc) and relative morbidity coefficient (Rmc). There were proposed terms of flap physiological availability and enforced availability.Passing each treated case through these terms permitted us to elaborate a modern algorithm of basic flap and reserve type selection for a concrete localization of defect. Theoretical and applicative value of the study. For the first time it was accomplished a study regarding the tegumentary availability of flaps donor regions in the lower limb. For the first time in sanitary system of the Republic of Moldova there were implemented the shank neurocutaneous flaps, anterior and posterior tibial flaps, fibular flaps, medial plantar flap of the foot, buttock and supramalleolar flaps. For plastic surgeon these changes offer four types of migration techniques: proximal and distal migration by „alignment” and „reverse” tecniques. It was modified essentially the defects treatment tactics with island flaps, migrated distally. A staging flap transfer was proposed in aim of preventing vascular complications. There were improved and specified indications and contraindications for plasty with the lower limb’s island flaps. It was elaborated a new algorithm of flaps selection based on utility coefficient, postoperative sensitive adaptation, morbidity, physiological an enforced availability. Research results implementation. The basic principles and practical recommendations are used in the lower limb’s defects treatment in Microsurgery and Traumatology Departments within National Scientific-Practical Emergency Medicine Center, as well as in the departments of Traumatology and Orthopedics Clinic, Central Military Hospital, traumatologic departments of Central Raional Hospitals from Causeni and Telenesti. Theoretical and practical results of the study are used during didactic process within Traumatology, Orthopedics and Campaign Surgery Chair of State Medical and Pharmaceutical University „Nicolae Testemitanu”. By this research five patents have been applied in practice.