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Putting Flaps Back To Work: Restoring Limb Function Through Innovative Flap Design
Juan L. Rendon
Rajiv Y. Chandawarkar
The Ohio State University Wexner Medical Center
2018-02-14
Presenter: Juan L Rendon
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Gregory Pearson
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose: Reconstructive surgery has traditionally been 'form-centric'. Most flaps restore 'form' first - and by happenstance, restore function. Particularly true in limb-salvage, the traditional reconstructive bias is 'to-obtain-robust-coverage'. Limb-function, an afterthought, merely follows form. Here, we present a contrarian model using three illustrative case-scenarios wherein we utilized flaps to primarily restore limb-function. 'Robust-coverage' simply followed.
Methods: First scenario, two patients that underwent a partial calcanectomy with consequential segmental loss of the plantar flexors were reconstructed with vascularized reverse sural fasciocutaneous flaps that were carefully interposed between the segmental defect (Achilles-tendon-to-plantar-fascia), thereby restoring functional continuity. In the second scenario, a patient with a traumatic loss of a substantially large segment of the triceps was reconstructed using an innervated latissimus muscle interposed to restore triceps function. The last patient had a massive rotator-cuff tear; here, we used an innervated latissimus tendon to restore shoulder function. In all four cases, the most critical surgical step involved meticulous calculation of the defect-size in the resting-state followed by precise inset of a size-matched flap measured at-rest (operative video-documentation available).
Results: In each scenario, complete functional restoration was achieved. Both patients with lower limb reconstruction regained 5/5 plantar flexion and resumed ambulation. In the upper extremity, triceps recovery was 5/5 and shoulder function (measured by ASIS score) was optimally restored, respectively.
Conclusion: Designing flaps that restore function requires a shift in ones focus – wherein 'form' follows 'function'. While feasible, this demands keen attention to operative-detail. When successful, functional flaps can improve patient-outcomes dramatically.
