Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Asklepios Hospital Harburg, Hamburg, Germany.
Z Orthop Unfall. 2022 Aug;160(4):422-430. doi: 10.1055/a-1373-6564. Epub 2021 Apr 19.
Reconstruction of lower extremity soft tissue defects is an exceptional surgical challenge, especially in multimorbid, elderly and severely ill patients with their thin and tense local soft-tissue conditions and increased perioperative risk. The distally based peroneus brevis muscle flap (DPBM), a local flap based on the muscular branches of the fibular artery, could pose a pragmatic solution. The objective of this study was to evaluate and quantify DPBM defect reconstruction in the lower leg, especially in elderly, multimorbid and severely ill patients.
The DPBM as a surgical option in defect reconstruction in multimorbid, elderly, severely ill patients (inclusion criteria: at least 3 pre-existing comorbidities, patient age: at least 55 years, ASA status: at least III) was evaluated in a retrospective single-centre study from 01 April 2014 to 31 December 2019. The electronic SAP health records (EHR) were analysed according to 18 criteria, including patient details, extent of multimorbidity, defect characteristics, clinical outcome, and complications.
Ten patients with a mean age of 72.6 years, a mean number of 8.5 pre-existing comorbidities and a mean ASA status of 3.1 met the inclusion criteria. The leading causes of defects, each with exposed tendons, bones, joint capsule, or joint, were chronic ulcers (n = 5) and soft tissue defects resulting from fractures (n = 3). In case of DMPB the success rate was 100% (no partial or total loss) with a short operating time (mean: 103 min) and a brief postoperative length of stay (mean: 11 d). In 2 patients (20%), DPBM surgery had to be discontinued intraoperatively and an alternative technique of defect reconstruction had to be adopted. The reasons included impaired muscle perfusion and fatty degeneration of the peroneus brevis muscle.
The DPBM flap allows straightforward, fast and safe defect reconstruction in the lower extremity, particularly in elderly, multimorbid and severely ill patients at risk. In patients with inadequate peroneal brevis muscle, however, DMPB surgery should be discontinued intraoperatively and the defect reconstructed using alternative techniques.
下肢软组织缺损的重建是一项特殊的外科挑战，尤其是在患有多种合并症、高龄和重症的患者中，这些患者局部软组织薄而紧张，围手术期风险增加。基于腓动脉肌支的腓骨短肌皮瓣（DPBM）是一种局部皮瓣，可能是一种实用的解决方案。本研究的目的是评估和量化 DPBM 在小腿缺损重建中的应用，特别是在高龄、患有多种合并症和重症的患者中。
从 2014 年 4 月 1 日至 2019 年 12 月 31 日，我们对患有多种合并症、高龄、重症的患者（纳入标准：至少有 3 种并存疾病，患者年龄：至少 55 岁，ASA 分级：至少 III 级）采用 DPBM 作为手术选择进行了回顾性单中心研究。根据 18 项标准，包括患者详细信息、合并症严重程度、缺损特征、临床结果和并发症，对电子 SAP 健康记录（EHR）进行了分析。
10 名患者符合纳入标准，平均年龄 72.6 岁，平均合并症 8.5 种，ASA 分级 3.1。导致缺损的主要原因是慢性溃疡（n=5）和骨折导致的软组织缺损（n=3），这些缺损都伴有暴露的肌腱、骨骼、关节囊或关节。采用 DPBM 的成功率为 100%（无部分或完全丢失），手术时间短（平均 103 分钟），术后住院时间短（平均 11 天）。有 2 名患者（20%）在术中不得不停止 DPBM 手术，而采用了其他方法进行缺损重建。原因包括腓骨短肌的血供受损和脂肪变性。
DPBM 皮瓣可在下肢，尤其是在患有多种合并症、高龄和重症的高危患者中，进行简单、快速和安全的缺损重建。然而，对于腓骨短肌不足的患者，应在术中停止 DPBM 手术，并采用其他技术重建缺损。
