AI Article Synopsis
- Lower extremity trauma often requires flap transfer for reconstruction, with the goal of achieving thin tissue coverage, which usually involves secondary debulking of the flap.
- The study compares two debulking methods: conventional lipectomy and liposuction followed by excision of excess flap tissue, analyzing patient demographics, surgical details, and outcomes.
- Results indicate similar postoperative complication rates for both methods, though liposuction leads to significant initial decreases in flap perfusion, which may not predict actual flap necrosis or complications accurately.
Article Abstract
Background: Lower extremity trauma often necessitates reconstruction with flap transfer. One of the reconstructive goals is a thin soft tissue coverage with appropriate contour. Therefore, a secondary debulking of the flap is usually performed.
Methods: Debulking through conventional lipectomy is compared with liposuction followed by excision of the defatted flap excess. Demographic data, surgical details, and postoperative outcomes are compared and analyzed. The perfusion dynamics of the flaps undergoing liposuction debulking are studied by means of perioperative indocyanine green fluorescence angiography, as well as postoperative laser Doppler imaging.
Results: Patients undergoing lipectomy ( = 69; 57.5%) or liposuction ( = 51; 42.5%) debulking had a similar rate of postoperative complications. Partial necrosis was observed in 7.2% (lipectomy) versus 7.8% (liposuction) of flaps. Fluorescence angiography showed a substantial decrease in flap perfusion following the infiltration with an epinephrine-containing tumescent solution (74.3% ± 8.2% prior to infiltration versus 16.8% ± 7.1% after infiltration; < 0.001), resulting in a dark flap appearance. Laser Doppler imaging confirmed the hypoperfusion on postoperative day 1.
Conclusion: Secondary debulking of a lower extremity flap can be safely and efficiently performed through liposuction combined with peripheral excision of the defatted flap in a single stage. Perfusion studies may show a misleading hypoperfusion of the defatted flap, which does not accurately predict subsequent necrosis or complications.
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| http://dx.doi.org/10.1055/s-0043-1777325 | DOI Listing |
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