Massachusetts General Hospital, Boston, MA, USA.
Foot Ankle Int. 2013 Dec;34(12):1695-700. doi: 10.1177/1071100713500655. Epub 2013 Aug 1.
Protected elevation represents a critical component of postoperative care, particularly in posteriorly located flaps, to prevent pressure on the flap's vascular pedicle and ensure a successful skin graft. Although several short case series and technique papers have described kickstand placement to prevent heel ulcers as an adjuvant to fixator placement for fracture management, there remains a paucity of reports describing external fixator placement solely for extremity elevation and pressure alleviation in the postoperative care of flap coverage procedures.
Patients who underwent lower extremity free flap coverage procedures requiring temporary elevation were included. Age, diagnosis, soft tissue procedures performed, type of external fixator placed, duration of frame placement, mode of removal, and complications related to external fixator placement were documented. Patients requiring external fixator placement for fracture management were excluded.
Twelve patients with 13 lower limb soft tissue defects were included in our case series. A thin-wire ring external fixator kickstand was applied in 5 limbs while the rest underwent placement of a uniplanar carbon fiber bar type external fixator kickstands. The average time for removal of the frames was 4 weeks. No complications were reported from kickstand placement.
The use of external fixator kickstands is an effective and safe adjuvant to soft tissue flap procedures for the lower extremity. Our case series is the largest in the literature and first to address the technical considerations for frame placement, positioning, and removal for external fixator kickstands placed solely for flap coverage procedures.
Level IV, retrospective case series.
保护抬高是术后护理的一个关键组成部分，特别是对于位于后部的皮瓣，以防止皮瓣的血管蒂受压，并确保皮瓣移植成功。尽管有几项短篇病例系列和技术论文描述了将支架放置在足跟下以预防足跟溃疡，作为骨折管理中固定器放置的辅助手段，但仍缺乏仅为下肢抬高和缓解压力而放置外固定器的报告，用于皮瓣覆盖手术的术后护理。
纳入需要临时抬高下肢的游离皮瓣覆盖手术患者。记录患者的年龄、诊断、进行的软组织手术、放置的外固定器类型、框架放置时间、移除方式以及与外固定器放置相关的并发症。排除因骨折管理而需要外固定器放置的患者。
我们的病例系列纳入了 12 例 13 个下肢软组织缺损患者。5 个肢体应用了细钢丝环外固定器支架，其余肢体应用了单平面碳纤维棒型外固定器支架。平均移除框架的时间为 4 周。支架放置无并发症。
外固定器支架的使用是下肢软组织皮瓣手术的一种有效且安全的辅助手段。我们的病例系列是文献中最大的病例系列，也是第一个针对仅用于皮瓣覆盖手术的外固定器支架的框架放置、定位和移除的技术考虑进行讨论的病例系列。
IV 级，回顾性病例系列。
