Mikrocerrahi onarýmýn mümkün olmadýðý kompleks alt ekstremite defektlerinde rekonstrüksiyon seçeneði: Randomize bipediküllü flepler

AMAÇ: Alt ekstremite defektleri travma, periferik arter hastalýðý, diyabetik ayak enfeksiyonlarý, tümör rezeksiyonu, ateþli silah yaralanmalarý ve yanýklar gibi birçok etiyolojik nedene baðlý olarak ortaya çýkabilir. Alt ekstremite defektleri, etkilenen anatomik lokalizasyona, doku miktarýna ve doku içeriðine göre geniþ bir klinik görünüm gösterir. Bu çalýþmada, serbest flep gibi mikrocerrahi onarýmlarýn mümkün olmadýðý durumlarda basit ve güvenilir bir kurtarma yöntemi olarak bipediküllü fleplerin kullanýmýnýn sunulmasý amaçlandý.
GEREÇ VE YÖNTEM: Mart 2018-Eylül 2021 tarihleri arasýnda alt ekstremitelerinde yumuþak doku defekti olan hastalar dosya üzerinden geriye dönük olarak tarandý. Bu hastalardan bipediküllü flep ile rekonstrüksiyon yapýlan hastalar çalýþmaya alýndý. Hastalar en az 12 ay düzenli olarak takip edildi. Takiplerde hastalarýn fotoðraflarý çekildi, flep viabilitesi, dehisens, yumuþak doku enfeksiyonu açýsýndan fizik muayene yapýldý ve veriler kayýt altýna alýndý.
BULGULAR: Alt ekstremitede defekt saptanan ve randomize bipediküllü flep ile onarým yapýlan 23 hasta geriye dönük olarak incelendi. Defekt yeri 4 hastada bacaðýn orta 1/3’ünde, 19 hastada ise bacaðýn 1/3 distalindeydi. Flep tasarýmý 22 hastada vertikal, 1 hastada transvers olarak yapýldý. Defekt onarýmý için 14 hastada 1 adet, 9 hastada 2 adet bipediküllü flep kullanýldý. Hastalarýn 16’sýnda donör alan onarýmý için cilt greftleri kullanýlýrken, 7’sinde donör alan primer olarak onarýldý. Postoperatif dönemde 5 hastada lokal yumuþak doku enfeksiyonu, 3 hastada yara yerinde ayrýlma tespit edildi ve antibiyotik tedavisi, resütürasyon ve uygun yara bakýmý ile sorunsuz iyileþme saðlandý. Hiçbir hastada flep veya greft kaybý gibi majör komplikasyon yaþanmadý.
SONUÇ: Sonuç olarak, orta ve distal alt ekstremite defektlerinin rekonstrüksiyonunda randomize bipediküllü flepler güvenilir bir seçenektir. Diyabetes mellitus ve periferik arter hastalýðý gibi yara iyileþmesini olumsuz etkileyen komorbiditeleri olan hastalarda bile kullanýlabilmesi nedeniyle alt ekstremitenin küçük ve orta büyüklükteki defektlerinde güvenle uygulanabilecek bir rekonstrüksiyon seçeneði olduðunu düþünüyoruz.

Reconstruction option in complex lower extremity defects where microsurgical repair is not possible: Randomized bipedicled flaps

BACKGROUND: Lower extremity defects may occur due to many etiological causes such as trauma, peripheral arterial disease, diabetic foot infections, tumor resection, gunshot injuries, and burns. Lower extremity defects show a wide clinical presentation ac-cording to the affected anatomical localization, amount of tissue, and tissue content. In this study, it is aimed to present the use of bipedicled flaps as a simple and reliable salvage method in cases where microsurgical repairs such as free flaps are not possible.
METHODS: Patients with soft-tissue defect in their lower extremities between March 2018 and September 2021 were scanned retrospectively over the file. Among these patients, patients who were repaired with a bipedicle flap were included in the study. The patients were followed up regularly for at least 12 months. During the follow-ups, the patients were photographed, a physical examination was performed in terms of flap viability, wound dehiscence, and soft-tissue infection, and the data were recorded.
RESULTS: In this study, 23 patients with a defect in the lower extremity who were repaired with randomized bipedicled flap were retrospectively analyzed. In four patients, the location of the defect was located in the middle 1/3 of the leg, while in 19 patients, it was located in the distal 1/3 of the leg. The flap design was done vertically in 22 patients, and the flap design was done transversely in one patient. One bipedicled flap was used for defect repair in 14 patients, and two bipedicled flaps were used for defect repair in nine patients. While skin grafts were used for donor site repairs in 16 patients, the donor site was primarily repaired in seven patients. In the post-operative period, local soft-tissue infection was detected in five patients and dehiscence at the wound site in three patients, and uneventful healing was achieved with antibiotic therapy, resuturation, and appropriate wound care. No major complications such as flap or graft loss were experienced in any of the patients.
CONCLUSION: Randomized bipediculated flaps are a very reliable option for the reconstruction of middle and distal lower extremity defects. We think that it is a reconstruction option that can be safely applied in small and medium-sized defects of the lower extremity, since it can be used even in patients with comorbidities such as diabetes mellitus and peripheral arterial disease that adversely affect wound healing.