Volume : VI, Issue : VI, June - 2016

GREAT SAPHENOUS FASCIOCUTANEOUS FLAP, A VERSATILE OPTION FOR COVERAGE OF COMPLEX LOWER LIMB DEFECTS.

Dr. Pradeep Goil, Dr. Ankit Jain, Dr. Nirmal Kumar Gupta

Abstract :

 INTRODUCTION : Reconstruction of the defects of leg and foot has always challenged the plastic surgeons and has encouraged them to look for more options. Before 1981 the only available option was that of random pattern flap with limited range of motion and limited length to width ratio. It was Ponten who revolutionized the concept of defect coverage by suggesting the inclusion of the fascia in the flaps. After this, the concept of perforator flaps, muscle flaps, neuro–fasciocutaneous flaps were introduced. Masquelet et al introduced the concept that there is a rich plexus of vessels around the superficial nerves on which we can raise neuro–fasciocutaneous flap, thereby increasing the options of lower limb defect coverage. This study aims at describing the versatility of saphenous flap in reconstructing defects of leg and foot and to develop a classification scheme for the same. MATERIAL AND METHOD : This study is a retrospective analysis of charts of patients with defects of leg and foot who underwent various saphenous flap cover at the Department of Plastic and Reconstructive surgery between January 2014 to Feuary 2016. A total of 31 patients with soft tissue defect of leg an foot were included in the study. There were 28 males and 3 females with average age of 40years(19–60 years). Most common cause of injury was road traffic accidents followed by post–burn defects. The defects were present on the anterior and lateral aspect of the knee, dorsum of the foot, sole and the opposite leg. Hand held Doppler was used to mark the perforators preoperatively. Saphenous flaps were classified as proximally, distally based flaps, propeller flap, cross leg flap and saphenous free flap. RESULTS : All flaps were planned preoperatively and perforators were marked. The size of the flaps ranged between 24–216 sq. cm. Of 31 patients, 13 patients underwent coverage with proximally based saphenous flap, 9 patients had distal saphenous flap coverage, 3 had propeller flap and 5 defects were covered with cross leg saphenous flap. One patient with defect over the dorsum of foot underwent saphenous free flap cover. All flaps were uneventful with full recovery except in 4 patients, 3 patients had partial necrosis of the flap (2 patients with distal saphenous flap, 1 with propeller flap cover). These changes were attributed to venous congestion and the flap was later deided and left to granulate and then split skin grafting was done. Fourth patient had cross leg saphenous flap cover and had complete necrosis of the flap due to generalized atherosclerotic disease. There was no donor site morbidity in any case. CONCLUSION : The saphenous fasciocutaneous flap is reliable and versatile in both flap design and elevation. Different types of this flap can meet the demands of different defect sizes and locations. Furthermore, a satisfactory functional and aesthetic result can be achieved with minimal donor site morbidity.

Keywords :

Article: Download PDF   DOI : 10.36106/ijar  

Cite This Article:

DR. PRADEEP GOIL, DR. ANKIT JAIN, DR. NIRMAL KUMAR GUPTA GREAT SAPHENOUS FASCIOCUTANEOUS FLAP, A VERSATILE OPTION FOR COVERAGE OF COMPLEX LOWER LIMB DEFECTS. Indian Journal of Applied Research, Vol.6, Issue : 6 JUNE 2016

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