Medial Tab Flap for Soft Tissue Defects of the Leg

NCT ID: NCT05864963

Last Updated: 2023-05-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

64 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-01-20

Study Completion Date

2022-12-30

Brief Summary

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Selecting the right technique for lower limb soft tissue reconstruction is a therapeutic challenge. Despite having several reconstruction options, it's important to choose a technique that is effective and with the least possible donor site morbidity for the patient.

Objective: demonstrate the therapeutic efficacy of the medial tab flap in soft tissue reconstruction on the leg, compared to conventional flaps.

Materials and methods: Cohort study matched with Propensity Score Matching (PSM) by age. 64 patients with soft tissue defects were selected and followed up to one year postoperatively. Outcome variables: surgical time in minutes, healing, healing time in days, complications.

Detailed Description

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Conditions

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Leg Coverage Defects

Study Design

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Observational Model Type

COHORT

Study Time Perspective

RETROSPECTIVE

Study Groups

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Intervention group

18 patients treated with medial tab-type fasciocutaneous flaps

Medial tab-type fasciocutaneous flap

Intervention Type PROCEDURE

The flap can be taken in different ways depending on the defect. Once the base of the flap is identified, the posterior edge of the tibia is taken as reference; marking of the tab is performed considering that the posterior incision is located 5 cm from the posterior edge of the tibia, and the anterior incision is located longitudinally of the medial region of the tibial diaphysis, the length of the incision depends on the base of the flap and the defect's size.

The posterior incision is made first in the skin, subcutaneous cellular tissue until the fascia is identified; the subfascial flap is dissected to avoid injuring perforators, dissection is completed up to the anterior edge of the flap, if needed direct cutaneous perforators are ligated; once the subfascial plane has been identified and dissected, the tab is completed in its proximal or distal part according to the previous surgical planning. Later, the tab is rotated to the anterior region of the tibia to cover the defect.

Control group

46 patients were randomly chosen, through Propensity Score Matching (PSM) the matching was performed with the age variable. The types of flaps considered were: 15 cases with sural flap, 18 with soleus flap, and 13 with a gastrocnemius flap

No interventions assigned to this group

Interventions

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Medial tab-type fasciocutaneous flap

The flap can be taken in different ways depending on the defect. Once the base of the flap is identified, the posterior edge of the tibia is taken as reference; marking of the tab is performed considering that the posterior incision is located 5 cm from the posterior edge of the tibia, and the anterior incision is located longitudinally of the medial region of the tibial diaphysis, the length of the incision depends on the base of the flap and the defect's size.

The posterior incision is made first in the skin, subcutaneous cellular tissue until the fascia is identified; the subfascial flap is dissected to avoid injuring perforators, dissection is completed up to the anterior edge of the flap, if needed direct cutaneous perforators are ligated; once the subfascial plane has been identified and dissected, the tab is completed in its proximal or distal part according to the previous surgical planning. Later, the tab is rotated to the anterior region of the tibia to cover the defect.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* diagnosis of soft tissue defects in the leg due to grade III B open fractures, or due to bone infection
* contraindication to using conventional flaps due to the following reasons: soft tissue injuries at the flap island site, injury to the vascular bed of the flap or injury of the flap structure (fascia, skin or muscle)
* people between 18 and 70 years of age

Exclusion Criteria

* Patients with a history of free flaps
* Whose clinical follow up couldn't be completed to assess outcomes were excluded.
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Fundación Campbell

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Fundacion Campbell

Barranquilla, Atlántico, Colombia

Site Status

Countries

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Colombia

References

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Rodríguez Lara JN, Ochoa Fletes MP. Serie de casos: colgajo sóleo-gastrocnemio en pacientes con defectos de partes blandas en miembros inferiores. Rev Med Hondur. 2021;89(2):131-6

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Martinov M, Argirova M. Fasciocutaneous flaps in the lower limb soft tissue reconstruction - A surgical case series. Orthoplastic Surg [Internet]. 2022;9(May):1-8. Available from: https://doi.org/10.1016/j.orthop.2022.05.002

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Friedrich JB, Katolik LI, Hanel DP. Reconstruction of soft-tissue injury associated with lower extremity fracture. J Am Acad Orthop Surg. 2011 Feb;19(2):81-90. doi: 10.5435/00124635-201102000-00003.

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Vergara-amador E. El uso de colgajos en la reconstrucción de defectos de cobertura en la pierna distal y dorso de pie The use of flaps in the reconstruction of defects of coverage in the distal leg and dorsum of the foots. 2013;29(1):74-82.

Reference Type BACKGROUND

MacKechnie MC, Flores MJ, Giordano V, Terry MJ, Garuz M, Lee N, Padilla Rojas LG, MacKechnie MA, Bidolegui F, Brown K, Quintero JE, Ding A, Sanchez Valenciano CG, Tabares Neyra H, Segovia J, Aguilar D, van Lieshout EM, Verhofstad MH, Miclau T. Management of soft-tissue coverage of open tibia fractures in Latin America: Techniques, timing, and resources. Injury. 2022 Apr;53(4):1422-1429. doi: 10.1016/j.injury.2022.01.027. Epub 2022 Jan 19.

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Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg. 1987 Mar;40(2):113-41. doi: 10.1016/0007-1226(87)90185-8.

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Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006 Jun;117(7 Suppl):261S-293S. doi: 10.1097/01.prs.0000222582.84385.54.

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Reference Type BACKGROUND

Mahajan RK, Srinivasan K, Singh M, Jain A, Kapadia T, Tambotra A. Management of Post-Traumatic Composite Bone and Soft Tissue Defect of Leg. Indian J Plast Surg. 2019 Jan;52(1):45-54. doi: 10.1055/s-0039-1688097. Epub 2019 May 8.

Reference Type BACKGROUND
PMID: 31456612 (View on PubMed)

Luo Z, Dong Z, Ni J, Wei J, Peng P, Lv G. Distally Based Peroneal Artery Perforator-Plus Fasciocutaneous Flap to Reconstruct Soft Tissue Defect Combined With Chronic Osteomyelitis in the Lateral Malleolus. Int J Low Extrem Wounds. 2022 Dec;21(4):464-470. doi: 10.1177/1534734620956782. Epub 2020 Sep 11.

Reference Type BACKGROUND
PMID: 32912022 (View on PubMed)

Akhtar S, Hameed A. Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg. 2006;59(8):839-45. doi: 10.1016/j.bjps.2005.12.009. Epub 2006 Mar 9.

Reference Type BACKGROUND
PMID: 16876082 (View on PubMed)

Economides JM, DeFazio MV, Golshani K, Cinque M, Anghel EL, Attinger CE, Evans KK. Systematic Review and Comparative Meta-Analysis of Outcomes Following Pedicled Muscle versus Fasciocutaneous Flap Coverage for Complex Periprosthetic Wounds in Patients with Total Knee Arthroplasty. Arch Plast Surg. 2017 Mar;44(2):124-135. doi: 10.5999/aps.2017.44.2.124. Epub 2017 Mar 15.

Reference Type BACKGROUND
PMID: 28352601 (View on PubMed)

Zweifel-Schlatter M, Haug M, Schaefer DJ, Wolfinger E, Ochsner P, Pierer G. Free fasciocutaneous flaps in the treatment of chronic osteomyelitis of the tibia: a retrospective study. J Reconstr Microsurg. 2006 Jan;22(1):41-7. doi: 10.1055/s-2006-931906.

Reference Type BACKGROUND
PMID: 16425121 (View on PubMed)

Roberts HJ, DeSilva GL. Can Sural Fasciocutaneous Flaps Be Effective in Patients Older Than 65? Clin Orthop Relat Res. 2020 Apr;478(4):734-738. doi: 10.1097/CORR.0000000000000963.

Reference Type BACKGROUND
PMID: 32229743 (View on PubMed)

Dhamangaonkar AC, Patankar HS. Reverse sural fasciocutaneous flap with a cutaneous pedicle to cover distal lower limb soft tissue defects: experience of 109 clinical cases. J Orthop Traumatol. 2014 Sep;15(3):225-9. doi: 10.1007/s10195-014-0304-0. Epub 2014 Jun 24.

Reference Type BACKGROUND
PMID: 24957508 (View on PubMed)

Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region. A preliminary report. Scand J Plast Reconstr Surg. 1983;17(3):191-6. doi: 10.3109/02844318309013118.

Reference Type BACKGROUND
PMID: 6673085 (View on PubMed)

Wee JT. Reconstruction of the lower leg and foot with the reverse-pedicled anterior tibial flap: preliminary report of a new fasciocutaneous flap. Br J Plast Surg. 1986 Jul;39(3):327-37. doi: 10.1016/0007-1226(86)90042-1.

Reference Type BACKGROUND
PMID: 3730678 (View on PubMed)

Erdmann MW, Court-Brown CM, Quaba AA. A five year review of islanded distally based fasciocutaneous flaps on the lower limb. Br J Plast Surg. 1997 Sep;50(6):421-7. doi: 10.1016/s0007-1226(97)90329-5.

Reference Type BACKGROUND
PMID: 9326145 (View on PubMed)

Bullocks JM, Hickey RM, Basu CB, Hollier LH, Kim JY. Single-stage reconstruction of Achilles tendon injuries and distal lower extremity soft tissue defects with the reverse sural fasciocutaneous flap. J Plast Reconstr Aesthet Surg. 2008;61(5):566-72. doi: 10.1016/j.bjps.2006.01.017. Epub 2007 Mar 26.

Reference Type BACKGROUND
PMID: 17369010 (View on PubMed)

Other Identifiers

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FC05052023

Identifier Type: -

Identifier Source: org_study_id

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