Lower Extremity Reconstruction: A Practical Guide

Description:

The state-of-the-art guide to lower extremity reconstruction from international experts

"I loved witnessing two generations of surgeons working together to capture it all: origin, evolution and progress, state of the art, and the future in one beautifully-crafted and exciting book. This is no doubt a must-read and must-have book." – from the Foreword by Fu-Chan Wei, MD

Adequate evaluation of lower limb wounds for salvage requires an itemized assessment of vascular, osseous, soft tissue, and functional deficits. Lower Extremity Reconstruction: A Practical Guide by renowned reconstructive surgeons and perforator flap masters J.P. Hong and Geoffrey G. Hallock presents an orthoplastic approach to this growing and challenging area of microsurgery. Throughout the well-illustrated text and videos, an impressive cadre of international surgeons share pearls and insights, including esoteric knowledge and step-by-step demonstration of techniques with pertinent case examples.

This unique guide presents a practical, visual, and stepwise approach to learning and mastering a full array of flap and microsurgery approaches for traumatic, dysvascular, metabolic, and oncologic lower limb defects. Organized into 26 topic-specific chapters, the book covers a full spectrum of lower extremity topics—from wound prep, timing, closure alternatives, and therapy, to soft-tissue tumors and a new concept in drop foot treatment. Numerous videos demonstrate how surgeons can leverage workhorse options to prevent chronic non-healing wounds or amputations and achieve the goal of limb salvage.

Key Highlights:

Lower extremity soft-tissue reconstruction techniques using local muscle and perforator workhorse flaps

Bone salvage and restoration techniques, including vascularized bone grafts

Diabetic foot management with in-depth discussion of the SCIP flap and perforator-to-perforator concept

Rationale for partial and subtotal foot amputation

27 videos and more than 600 illustrations enhance understanding of microsurgical interventions

With insights from top microsurgeons on how to achieve the best outcomes for patients with lower limb defects, this is a must-have resource for plastic and orthopaedic surgeons, especially specialists who treat patients at trauma centers.

Table of Contents:

1. Our Introduction to Lower Extremity Reconstruction

1.1 Introduction

1.2 History

1.3 Basic Principles

1.4 Conclusion

2. Assessment of the Normal and Impaired Lower Extremity

2.1 Introduction

2.2 Assessment of the Normal Lower Extremity

2.3 Assessment of the Impaired Lower Extremity

2.4 Compartment Syndrome

2.5 Degloving Injuries

2.6 Crush Syndrome

2.7 Osteomyelitis

2.8 Diabetic Foot

2.9 Conclusion

3. Indications for Vascular Intervention in Lower Extremity Reconstruction

3.1 Introduction

3.2 Principles of Limb Salvage

3.3 Anatomy

3.4 Vascular Evaluation

3.5 Plastic Surgery Indications for Vascular Surgical Intervention

3.6 Special Considerations for the “Vascular/Diabetic” Patient

4. Orthopaedic Evaluation of the Lower Extremity and the Concept of the Orthoplastic Approach

4.1 Introduction

4.2 The Orthoplastic Approach

4.3 Orthopaedic Evaluation of the Injured Extremity

4.4 The Role and Timing of Debridement

4.5 Basic Principles of Bone Fixation

4.6 Limb Salvage versus Amputation

4.7 Other Applications of Orthoplastic Surgery

4.8 Conclusion

5. Surgical Approach to Pediatric Bone and Soft-Tissue Tumors of the Lower Extremity

5.1 Introduction

5.2 Types of Sarcoma

5.3 Staging

5.4 Diagnosis

5.5 Surgical Management

5.6 Conclusion

6. Spare-Part Surgery

6.1 Introduction

6.2 Debridement

6.3 Extracorporeal Membrane Oxygenation Circuit

6.4 Tissue Graft

6.5 Fillet Flaps

6.6 Postoperative Care

6.7 Complications

7. Using the Flap and Angiosome Concepts to Optimize Functional Lower Leg and Foot Amputations

7.1 Introduction

7.2 Conclusion

8. Vascular Anatomy of the Lower Extremity: A Practical Guide to Vascular Territories, Perforators, and Selection of Recipient Vessels

8.1 Introduction

8.2 Vascular Territories and the Angiosome Concept

8.3 Arterial Territories

8.4 Venous Drainage

8.5 Neurovascular Territories

8.6 Vascular Anatomical Principles Applied to Flap Design

8.7 Main Source Vessels of the Lower Extremity

8.8 Regional Anatomy of Perforators of the Lower Extremity

8.9 Anatomical Regions

8.10 Selection of Recipient Vessels

9. Importance of Vascularity and Selecting the Recipient Vessels in Lower Extremity Reconstruction

9.1 Introduction

9.2 Factors to Consider

9.3 Algorithm for Selecting Recipient Vessel

9.4 Conclusion

10. General Wound Preparation and Timing

10.1 Introduction

10.2 Patient Optimization

10.3 Timing of Lower Extremity Coverage after Trauma

10.4 Wound Bed Preparation

10.5 Conclusion

11. The Pertinence of the Reconstructive Ladder and the Reconstructive Elevator

11.1 Introduction

11.2 From Wound Closure to Reconstruction

11.3 The Modern Era of Lower Extremity Reconstruction

11.4 The Reconstructive Elevator and the Lower Extremity

11.5 Conclusion

12. Nonflap Wound Closure Alternatives: Skin Graft, Skin Substitute, Skin Stretch, and Negative-Pressure Wound Therapy

12.1 Introduction

12.2 Negative-Pressure Wound Therapy

12.3 Split-Thickness Skin Graft

12.4 Skin Substitute for Additional Thickness

12.5 Serial Closure of the Wound

12.6 Skin Graft for a Chronic Ulcer

12.7 Conclusion

13. The Process for Flap Selection by Region of the Lower Extremity

13.1 Introduction

13.2 Selection According to the Recipient Site

13.3 Selection According to the Donor Site

14. The Basic Practical Lower Limb Muscle Local Flaps

14.1 Introduction

14.2 Chapter 14A: The Medial and Lateral Gastrocnemius Muscle Flaps

14.3 Chapter 14B: The Gracilis Local Muscle Flap

14.4 Chapter 14C: The Soleus Muscle Flap

14.5 Chapter 14D: The Vastus Lateralis Muscle Flap

15. Basic Local Perforator Flaps of the Lower Extremity

15.1 Introduction

15.2 Chapter 15A: The Island Perforator Flap

15.3 Chapter 15B: Perforator Advancement Flaps Including the Keystone Flap

15.4 Chapter 15C: The Peninsular Perforator Flap

15.5 Chapter 15D: The Perforator Propeller Flap

15.6 Chapter 15E: Medialis Pedis and Other Plantar Flaps

15.7 Chapter 15F: The Distally Based Sural Flap

16. Common Versatile Free Flaps for the Lower Extremity

16.1 Introduction

16.2 Chapter 16A: The Anterolateral Thigh Flap for Lower Extremity

16.3 Chapter 16B: The Gracilis Muscle Free Flap

16.4 Chapter 16C: The Versatile Latissimus Dorsi Muscle Free Flap

16.5 Chapter 16D: The Medial Sural Artery Perforator Flap

16.6 Chapter 16E: The Thoracodorsal Artery Perforator Free Flap

17. Supermicrosurgery Approach to the Lower Limb

17.1 Introduction

17.2 Attributes and Detriments

17.3 Anatomical Consideration

17.4 Anatomical Variants and Pitfalls

17.5 Surgical Approach

17.6 Postoperative Care Protocol

17.7 Conclusion

18. Diabetic Foot Reconstruction

18.1 Introduction

18.2 Attributes and Detriments

18.3 Considerations

18.4 Surgical Algorithm

18.5 Soft-Tissue Reconstruction

18.6 Postoperative Care

18.7 Conclusion

19. Rationale for Lower Limb Sensate Flaps

19.1 Introduction

19.2 Attributes and Detriments

19.3 Anatomical Considerations

19.4 Anatomical Variants and Potential Pitfalls

19.5 Flap Design and Harvest

19.6 Postoperative Care Protocols

19.7 Conclusion

20. A New Concept in Drop Foot Treatment: Ninković’s Technique—the Neuromusculotendinous Gastrocnemius Transfer

20.1 Introduction

20.2 Indications

20.3 Operative Technique

20.4 Postoperative Considerations

20.5 Complications

20.6 Outcomes

20.7 Conclusion

21. Modern Concepts of Prosthetic Rehabilitation in Amputation of the Lower Extremity

21.1 Introduction to Targeted Muscle and Sensory Reinnervation

21.2 Introduction to Osseointegration at Below- and Above-Knee Level of Amputation

21.3 Introduction to Femoral Shortening Osteotomy in Through-Knee Amputees

22. Procurement of Thin Flaps as Indicated in the Lower Extremity

22.1 Introduction

22.2 Anatomical Considerations

22.3 Anatomical Variants and Potential Pitfalls

22.4 Flap Design

22.5 Flap Harvest

22.6 Postoperative Care Protocols

22.7 Conclusion

23. Bone Flaps and Bone Transport for Lower Limb Reconstruction

23.1 Introduction

23.2 General Principles for Reconstruction of Bone Defects

23.3 Fibula Flap

23.4 Vascularized Rib

23.5 Medial Femoral Condyle Flap

23.6 Bone Transport and Distraction Osteogenesis

23.7 Summary

24. Surgical Treatment for Lower Extremity Lymphedema

24.1 Introduction

24.2 Definition of Lymphedema

24.3 Classification

24.4 Stage of Lymphedema

24.5 Symptoms and Complications

24.6 Diagnosis

24.7 Treatments

25. Lower Limb Vascularized Composite Allotransplantation

25.1 Introduction

25.2 Clinical Example of Lower Limb Vascularized Composite Allotransplantation

25.3 Discussion

25.4 Conclusion

26. Perioperative Care and Rehabilitation Specific to the Lower Limb

26.1 Introduction

26.2 Perioperative Optimization

26.3 Immediate Postoperative Management

26.4 Rehabilitation

Index

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