gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
72. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 94. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 49. Tagung des Berufsverbandes der Fachärzte für Orthopädie und Unfallchirurgie

22. - 25.10.2008, Berlin

Reconstruction of combined bone and soft-tissue defects in the foot and ankle with one-stage composite free tissue-transfer

Meeting Abstract

  • D.J. Schaefer - Universitätsspital Basel, Plastische, Rekonstruktive und Ästhetische Chirurgie, Basel, Switzerland
  • M. Haug - Universitätsspital Basel, Plastische, Rekonstruktive und Ästhetische Chirurgie, Basel, Switzerland
  • V. Valderrabano - Universitätsspital Basel, Orthopädische Klinik, Basel, Switzerland
  • P.E. Ochsner - Kantonsspital Liestal, Orthopädie und Traumatologie, Liestal, Switzerland
  • B. Hintermann - Kantonsspital Liestal, Orthopädische Klinik, Liestal, Switzerland
  • G. Pierer - Universitätsspital Basel, Plastische, Rekonstruktive und Ästhetische Chirurgie, Basel, Switzerland

Deutscher Kongress für Orthopädie und Unfallchirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 94. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie, 49. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 22.-25.10.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocWI68-1448

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dkou2008/08dkou427.shtml

Veröffentlicht: 16. Oktober 2008

© 2008 Schaefer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background of the study: Foot and ankle bone defects with overlying soft-tissue problems require the coordinate management by orthopedic and reconstructive surgeons. Microsurgical reconstruction using composite free flaps has improved foot salvage. Nevertheless free-tissue transfer to the foot and ankle often interferes with postoperative weight-bearing function. Thin pliable fasciocutaneous in combination with vascularized bone or bone grafts/substitutes are preferred in our treatment algorithm. The aim of the study was to evaluate retrospectively clinical outcome and complication rate of composite bone and soft tissue defects using osteocutaneous or fasciocutaneous free flaps with bone grafting.

Methods: Twenty-one patients who had composite defects of the foot and ankle after trauma or tumor resection were treated with the following protocol: defect evaluation, debridement, infection control, fracture fixation, early one stage soft-tissue and bony reconstruction. Eleven patients received combined microvascular reconstructions with iliac osteocutaneous flaps (n=8) or osteoseptocutaneous fibula flaps (n=3). Ten patients had microsurgical reconstructions with fasciocutaneous extended lateral arm flaps (n=8) or antero-lateral thigh flaps (n=2) combined with autologous bone grafting (n=7) or bone substitution materials (n=3). Complication and infection rate were calculated and functional results measured by pedography and gait analysis.

Results: One complete ALT flap loss was observed due to a progressive underlying infection in a case where bone substitutes were implanted. One extended lateral arm flaps in combination with bone grafting had distal partial skin loss of less than 15% of flap surface and healed secondarily. Primary bone union rate was achieved in ten of eleven cases of combined osteocutaneous reconstruction. The average primary union time was 6.1 months. Two infections occurred, when bone substitutes were used and required several reinterventions. All patients with complete bone healing achieved full weight bearing. Donor site problems were noted in all osteoseptocutaneous fibula flaps, in one iliac flap and in two iliac crest bone grafting cases.

Conclusion: Microvascular composite reconstruction of bone and soft tissue defects in foot and ankle led to successful functional results. Complication rate was lowest, when iliac osteocutaneous flaps were used. The use of bone substitutes to reduce donor site morbidity demonstrated a higher complication and infection rate. Therefore we emphasize the concept of single-stage reconstruction of combined tissue defects of the foot and ankle by composite free tissue transfer.