Alt Ekstremite Rekonstrüksiyonunda Kullanılan Çapraz Bacak Fleplerinde Fiksasyon Yöntemlerinin Karşılaştırılması

Öz

Amaç: Alt ekstremite geniş doku defektlerinin rekonstrüksiyonu zorlu bir süreçtir. Rekonstrüksiyon seçeneklerinden biri çapraz bacak fl epleridir. Çapraz bacak fl ebi operasyonlarında her iki alt ekstremitenin immobilize edilmesi gerekmektedir. Makalemizde kliniğimizde yapmış olduğumuz pediküllü ve serbest çapraz bacak fl eplerinde immobilizasyon yöntemleri ile ilgili tecrübelerimizi sunmaktayız.Gereç ve Yöntemler: 2007-2015 yılları arasında toplam 37 hastaya 6 kadın, 31 erkek , çapraz bacak fl ebi uygulandı. Hastaların ortalama yaşı 33’tü. 6-76 arası . 27 hastaya serbest çapraz bacak fl ebi uygulandı, 10 hastaya pediküllü çapraz bacak fl ebi uygulandı. 22 serbest, 3 pediküllü çapraz bacak fl ebi uygulanan toplam 25 hastaya eksternal fi ksatör ile fi ksasyon yapıldı. 5 serbest, 6 pediküllü çapraz bacak fl ebi uygulanan toplam 11 hastaya geleneksel alçı ile fi ksasyon uygulandı. Pediküllü çapraz bacak fl ebi yapılan 1 hastaya ise 3 adet steinmann çivisi ile fi ksasyon uygulandı.Bulgular: Serbest fl ep uygulanan hastaların 3 tanesinde, pediküllü fl ep yapılan hastalardan 2 tanesinde parsiyel fl ep kayıbı gözlenmiş olup yara debritmanı ve pansumanlarla tam iyileşme sağlanmıştır. Eksternal fi ksatör kullanılan hastaların 2 tanesinde topukta grade 2 bası yarası, 2 hastada ise grade 3 bası yarası görülmüş olup alçı kullanılan hastaların hepsinde ekstremitede hiperemi ve büllöz yaralar gözlenmiştir. Hiçbir hastada sinir, damar yaralanması, gözlenmemiş olup, alçı uygulanan hastalarda minimal eklem kontraktürü gözlenmiştir.Sonuç: Çapraz bacak fl eplerinde, immobilizasyon yöntemi olarak eksternal fi ksatör kullanımının fl ep başarısında, hasta bakım ve konforunda daha başarılı olduğunu savunmaktayız

Anahtar Kelimeler

• Çapraz bacak fl ebi, Alt ekstremite rekonstrüksiyonu, Eksternal fi ksatör

Comparison of Cross-leg Flap Fixation Methods Used in Lower Limb Reconstruction

Abstract

Objective: Reconstruction of traumatic soft tissue defects of the lower limb is usually challenging. One of the reconstruction options is cross-leg fl aps. Both lower extremities must be immobilized in cross-leg fl ap surgery. In this article, we present our clinical experience with immobilization of the lower extremities during pedicled or free cross-leg fl ap surgery.Material and Methods: A total of 37 patients consisting of 6 females and 31 males underwent cross-leg surgery between 2007 and 2015. The mean age was 33 range 6 to 76 years. We had 27 patients undergo free cross-leg surgery and 10 patients were treated with pedicled cross-leg fl aps. 25 patients 22 free and 3 pedicled were immobilized with external fi xators while 11 patients 5 free and 6 pedicled cross-leg patients were immobilized with a plaster cast. 1 pedicled cross-leg patient was immobilized with 3 Steinmann pins.Results: Partial necrosis occurred in 3 free cross-leg patients, and 2 pedicled cross-leg patients. Grade 2 pressure sores developed in 2 patients and grade 3 pressure sores developed in 2 patients immobilized with an external fi xator but healed completely with debridement and wound management. All plaster cast patients had hyperemia and bulloid wounds in their lower leg skin covered with a plaster cast. There was no nerve or vascular injury but minimal joint contractures occurred in patients immobilized with a plaster cast.Conclusion: In cross-leg surgery, we advocate that use of an external fi xator as an immobilization method as it leads to higher fl ap surgery success rate and is better for patient comfort and care

Keywords

• Cross-leg fl ap, Lower limb reconstruction, External fi xator

References

1. 1. Lu L, Liu A, Zhu L, Zhang J, Zhu X, Jiang H. Crossleg fl aps: Our preferred alternative to free fl aps in the treatment of complex traumatic lower extremity wounds. J Am Coll Surg 2013;217:461-71.
2. 2. Taylor GI, Townsend , Corlett R. Superiority of the deep circumfl ex iliac vessels as the supply for free groin fl aps. Plast Reconstr Surg 1979;64:745-59.
3. 3. Contendini F, Negosanti L, Fabbri E, Pinto V, Tavaniello B, Sgarzani R, Cipriani R. Cross-leg as salvage procedure after free fl ap transfer failure: A case report. Case Reports in Orthopedics 2012: Article ID 205029.
4. 4. Padgett EC, Gaskins JH. The use of skin fl aps in the repair of scarred or ulcerative defects over bone and tendons. Surgery 1945;18:287.
5. 5. Stark RB. The cross-leg fl ap procedure. Plast Reconstr Surg 1952;9:173.
6. 6. Kolker AR, Kasabian AK, Karp NS, Gottlieb JJ. Fate of free fl ap microanastomosis distal to the zone of injury in lower extremity trauma. Plast Reconstr Surg 1997;99:1068-73.
7. 7. Stompro BE, Stevenson TR. Reconstruction of the traumatized leg: Use of distally based free fl aps. Plast Reconstr Surg 1994;93:1021-5.
8. 8. Serel S, Kaya B, Demiralp Ö, Can Z. Cross-leg free anterolateral thigh perforator fl ap: A case report. Microsurgery 2006;26:190-2.

9. 9. Akyurek M, Safak T, Ozkan O, Kecik A. Technique to re-establish continuity of the recipient artery after endto-end anastomoses in cross-leg free fl ap procedure. Ann Plast Surg 2002;49:430-3.
10. 10. Hallock GG. Medial sural gastrocnemius muscle perforator free fl ap: An immediate cross-leg fl ap? J Reconstr Microsurg 2005;21:217-23.
11. 11. Ladas C, Nicholson R, Ching V. The cross-leg soleus muscle fl ap. Ann Plast Surg 2000;45:612-5.
12. 12. Townsend PL. Indications and long-term assessment of 10 cases of cross-leg free DCIA fl aps. Ann Plast Surg 1987;19:225-33.
13. 13. Chen HC, El-Gammal TA, Wei FC, Chen HH, Noordhoff MS, Tang YB. Cross-leg free fl aps for diffi cult cases of leg effects: Indications, pitfalls, and long-term results. J Trauma 1997;43:486-91.
14. 14. Evans GA, Bang RL, Cornah MS, Corps BV. The value of the Hoffman skeletal fi xation in the management of cross-leg fl aps, particularly those injuries complicated by open fractures of the tibia. Injury 1979;11(2):110-4.
15. 15. Calhoun JH, Gogan WJ, Beraja V, Howard RJ, Oliphant JR. Dynamic axial fi xation for immobilization of cross-leg fl aps in chrpnic osteomyelitis. Ann Plast Surg1989;23(4):354-6.
16. 16. Eser C, Kesiktaş E, Gencel E, Aslaner EE, Yavuz M. An alternative method to free fl ap for distal leg and foot defects due to electrical burn injury: Distally Based CrossLeg Sural Flap. Ulus Travma Acil Cerrahi Derg. Baskıdaki makaleler: DOI: 10.5505/tjtes.2015.