Ravikiran Naalla,Shashank Chauhan,Aniket Dave,Maneesh Singhal.[J].中华创伤杂志英文版,2018,21(6):338-351
Reconstruction of post-traumatic upper extremity soft tissue defects withpedicled flaps: An algorithmic approach to clinical decision making
  
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KeyWord: AlgorithmUpper limbSoft tissue defectReconstructionPedicled flapsDecision making
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Author NameAffiliation
Ravikiran Naalla Department of Plastic Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India 
Shashank Chauhan Department of Plastic Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India 
Aniket Dave Department of Plastic Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India 
Maneesh Singhal Department of Plastic Reconstructive & Burns Surgery, All India Institute of Medical Sciences, New Delhi, India 
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Abstract:
      Purpose: Pedicled flaps are still the workhorse flaps for reconstruction of upper limb soft tissue defects in many centers across the world. They are lifeboat options for coverage in vessel deplete wounds. In spite of their popularity existing algorithms are limited to a particular region of upper limb; a general algorithm involving entire upper limb which helps in clinical decision making is lacking. We attempt to propose one for the day to day clinical practice. Methods: A retrospective analysis of patients who underwent pedicled flaps for coverage of posttraumatic upper extremity (arm, elbow, forearm, wrist & hand) soft tissue defects within the period of January 2016 to October 2017 was performed. Patients were divided into groups according to the anatomical location of the defects. The flaps performed for different anatomical regions were enlisted. Demographic data and complications were recorded. An algorithm was proposed based on our experience, with a particular emphasis made to approach to clinical decision making. Results: Two hundred and twelve patients were included in the study. Mean age was 27.3 years (range: 1-80 years), 180 were male, and 32 were female. Overall flap success rate was 98%, the following complications were noted marginal flap necrosis requiring no additional procedure other than local wound care in 32 patients (15%), partial flap necrosis requiring flap advancement or extra flap in 15 patients (7%), surgical site infection in 11 patients (5%), flap dehiscence requiring re-suturing in 5 patients (2.4%), total flap necrosis 4 patients (2%). Conclusion: The proposed algorithm allows a reliable and consistent method for addressing diverse soft tissue defects in the upper limb with high success rate.
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