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The current state of the problem of soft tissue defects replacement in the lower extremities in conditions of chronic osteomyelitis

https://doi.org/10.35401/2500-0268-2022-25-1-69-76

Abstract

Based on the data of scientific literature, the current state of the problem of soft tissue defects replacement in the lower extremities in conditions of chronic osteomyelitis has been analyzed. Taking into account certain requirements for the replacement of defects of this nature, the following reconstructive tasks have been indicated. First of all, for adequate restoration of the skin with simultaneous relief of the purulent-necrotic process, it is necessary to use blood-supplied tissue complexes, which, if possible, should be formed from tissues similar to those surrounding the defect. The predominant use of technically and economically beneficial interventions is of great importance. The most suitable are loco-regional flaps with axial blood supply, among which the most promising are perforant flaps. It is necessary to develop an algorithm for defects reconstruction using loco-regional perforant flaps, depending on the defect area. It is also necessary to conduct a comparative analysis of the anatomical advantages and effectiveness of using various perforant and insular flaps on the vascular pedicle. A one-stage orthoplastic approach will allow the most effective use of the achievements of reconstructive plastic surgery in orthopedics to restore limb function, which will improve the results of treatment of patients.

About the Authors

D. O. Rumyantsev
Stavropol Regional Clinical Hospital
Russian Federation

Dmitry O. Rumyantsev, Orthopedic traumatologist, Traumatological and Orthopedic Purulent Department no. 2

1, Semashko str., Stavropol, 355030



G. A. Airapetov
Stavropol Regional Clinical Hospital; Stavropol State Medical University
Russian Federation

Alexander A. Vorotnikov, Dr. Sci. (Med.), Professor, Head of the Department of Traumatology and Orthopedics

Stavropol



A. A. Vorotnikov
Stavropol Regional Clinical Hospital; Stavropol State Medical University
Russian Federation

Georgy A. Airapetov, Dr. Sci. (Med.), Associate Professor, Department of Traumatology and Orthopedics

Stavropol



References

1. Chervyakov AV. Surgical treatment of extensive defects of leg tissue. Dissertation. Moscow; 2009:101. (In Russ.).

2. Rak AV, Nikitin GD, Linnik SA. Chronic osteomyelitis and its treatment. Abstracts of the VII Congress of Traumatologists and Orthopedists of Russia. Novosibirsk; 2002:355–356. (In Russ.).

3. Cierny G, Mader JT, Pennick JJ. A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res. 2003;414:7–24. PMID: 12966271. http://doi.org/10.1097/01.blo.0000088564.81746.62

4. Steed DL. Debridement. Am J Surg. 2004;187(5A):71–74. PMID: 15147995. http://doi.org/10.1016/S0002-9610(03)00307-6

5. Nikitin GD, Rak AB, Linnik SA, et al. Surgical treatment of osteomyelitis. Saint Petersburg: Russian graphics; 2000:288. (In Russ.).

6. Kernerman RP, Mosunov SA. Late results of surgical treatment of chronic gunshot and hematogenous osteomyelitis of the extremities. Orthopedics and Traumatology. 1976;6:16–18. (In Russ.). PMID: 1018896.

7. Savelyeva VI, Rodyukova EN. Bone transplantation. Novosibirsk: 1992:217. (In Russ.).

8. Shapovalov VM, Ovdenko AG. Gunshot osteomyelitis. Saint Petersburg: Morsar AV; 2000:144. (In Russ.).

9. Pyatakov SN, Porhanov VA, Bensman VM, et al. Study of the dosing tissue distraction clinical efficacy in the soft tissue defects treatment of various etiologies in the lower extremities. Innovative Medicine of Kuban. 2019;14(2):36–44. (In Russ.). http://doi.org/10.35401/2500-0268-2019-14-2-36-44

10. Kuzin MI, Kosyuchenok BM. Wounds and wound infection. Guidelines for doctors. Moscow: Medicine; 1990:593. (In Russ.).

11. Grinev MV. Technical possibilities of muscular plastics of osteomyelitic cavities. Bulletin of Surgery. 1964;6:130–139. (In Russ.).

12. Urist MR, McLean FC. Recent advances in physiology of bone. J Bone Joint Surg. 1963;45:1305–1313. PMID: 14078540.

13. Pekshev AV. The use of blood­supplied skin and bone flaps in the treatment of osteomyelitis of the foot bones and lower part of the leg. Dissertation. Tomsk; 2005:144. (In Russ.).

14. Rodomanova LA, Polkin AG. Reconstructive microsurgery of the upper limbs. Traumatology and Orthopedics of Russia. 2006;4:15–19. (In Russ.).

15. Delinikaitis SV, Ostrovsky NV. Plastic surgery of the skin traumatic defects of the extremities. Treatment of combined in­ juries and diseases of the extremities. Moscow: 2003:95–97. (In Russ.).

16. Kutyanov DI. The use of technologies of reconstructive plas­ tic microsurgery in the process of treatment of patients with pathology of large joints and periarticular structures of the extrem­ ities. Dissertation. Saint Petersburg; 2014:386. (In Russ.).

17. Tsai J, Liao HT, Wang PF, et al. Increasing the success of reverse sural flap from proximal part of posterior calf for traumatic foot and ankle reconstruction: patient selection and surgical refinement. Microsurgery. 2013;33(5):342–349. PMID: 23653382. http://doi.org/10.1002/micr.22099

18. Pontén B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34:215–220. PMID: 7236984. http://doi.org/10.1016/s0007-1226(81)80097-5

19. Tolhurst DE, Haeseker B, Zeeman RJ. The development of the fasciocutaneous flap and its clinical applications. Plast Reconstr Surg. 1983;71(5):597–606. PMID: 6836058. http://doi.org/10.1097/00006534-198305000-00001

20. Niranjan NS, Price RD, Govilkar P. Fascial feeder and perforator-based V-Y advancement flaps in the reconstruction of lower limb defects. Br J Plast Surg. 2000;53(8):679–89. PMID: 11090325. http://doi.org/10.1054/bjps.2000.3428

21. Nakajima H, Fujino T, Adachi S. A new concept of vascular supply to the skin and classification of skin flaps according to their vascularization. Ann Plast Surg. 1986;16(1):1–19. PMID: 3273007. http://doi.org/10.1097/00000637-198601000-00001

22. Cormack GC, Lamberty BGH. The arterial anatomy of skin flaps. Edinburg: Churchill Livingstone; 1986;536.

23. Hallock GG. Fasciocutaneous Flaps. Boston: Blackwell Scientific Publications; 1992.

24. Blondeel PN, Morris SF, Hallock GG, et al. Perforator flaps. Anatomy, technique and clinical applications. Missouri: Quality Medical Publishing; 2013:1096.

25. Taylor GI, Palmer JH, McManamny D (eds). The vascular territories of the body (angiosomes) and their clinical applications. Philadelphia: WB Saunders; 1990.

26. Taylor GI, Aston SJ, Beasley RW, et al (eds). The blood supply of the skin. Grabb and Smith’s Plastic Surgery. Philadelphia: Lippincott-Raven; 1997:1156.

27. Morris SF, Tang M, Almutairi K, et al. The anatomic basis of perforator flaps. Clin Plast Surg. 2010;37(4):553–570. PMID: 20816512. http://doi.org/10.1016/j.cps.2010.06.006

28. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg. 1991;44(1):53–54. PMID: 1993239. http://doi.org/10.1016/0007-1226(91)90179-n

29. Hallock GG. The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg. 2006;56(5):540–542. PMID: 16641632. http://doi.org/10.1097/01.sap.0000210512.81988.2b

30. Teo TC. The propeller flap concept. Clin Plast Surg. 2010;37(4):615–626. PMID: 20816517. http://doi.org/10.1016/j.cps.2010.06.003

31. Wallace CG, Kao HK, Jeng SF, et al. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg. 2009;124:e419–e426. PMID: 19952709. http://doi.org/10.1097/PRS.0b013e3181bcf189

32. Hallock GG. A paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps. J Reconstr Microsurg. 2013;29(4):233–240. PMID: 23463497. http://doi.org/10.1055/s-0032-1328919

33. Guerra AB, Gill PS, Trahan CG, et al. Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit SI perforator and latissimus dorsi musculocutaneous flaps. J Reconstr Microsurg. 2005;21(2):137–143. PMID: 15739152. http://doi.org/10.1055/s-2005-864848

34. Misra A, Niranjan NS. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg. 2005;115(6):1625–1632. PMID: 15861067. http://doi.org/10.1097/01.prs.0000161255.33398.bf

35. Papaioannou K, Lallos S, Mavrogenis A, et al. Unilateral or bilateral V-Y fasciocutaneous flaps for the coverage of soft tissue defects following total knee arthroplasty. J Orthop Surg Res. 2010;5:82. PMID: 21050437. PMCID: PMC2988015. http://doi.org/10.1186/1749-799X-5-82


Review

For citations:


Rumyantsev D.O., Airapetov G.A., Vorotnikov A.A. The current state of the problem of soft tissue defects replacement in the lower extremities in conditions of chronic osteomyelitis. Innovative Medicine of Kuban. 2022;(1):69-76. (In Russ.) https://doi.org/10.35401/2500-0268-2022-25-1-69-76

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