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A defensive approach to muscle flaps of the leg

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Lower limb injuries are very common in high-speed trauma. Soft tissue cover over vital structures of the leg is of paramount importance as the ultimate goal of treatment is to have a stable and pain-free limb for walking. Though microvascular flaps are the gold standard in soft tissue coverage of the leg, pedicled medial gastrocnemius, hemi-soleus and fasciocutaneous flaps still hold an important role. The classical exposure of medial gastrocnemius and medial hemi-soleus flaps is posterior midline or an incision 2-cm medial to the tibial border. We describe a method of defensive approach for raising muscle flaps preserving the medial fasciocutaneous flap.

Methods

A retrospective study comprising of 45 patients from January 2014 to February 2020 who presented with leg defects which were managed by muscle flaps through defensive approach was done. The location of the defects, the aetiology, outcome and the complications were analysed.

Results

Of the 45 patients, 29 underwent medial gastrocnemius flaps, 11 hemi-soleus and 4 both. Among them, four had failure of initial muscle flaps which were salvaged with the delayed fasciocutaneous flap as a result of the defensive approach.

Conclusions

Defensive approach skin incision is a safe and easy way to raise muscle flaps in the leg which preserves the option for a fasciocutaneous flap as lifeboat if needed.

Level of evidence:

Level IV, therapeutic.

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Data Availability

All data supporting the findings of this study are available within the paper. It was acquired from the Medical Records Library of Government Medical College Kottayam(Aff1) after obtaining necessary permissions. No public database has been utilized for this study.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Plastic & Reconstructive Surgery, Government Medical College Kottayam, Kottayam-686008, Kottayam, Kerala, India

    Fobin Varghese & Lekshmi Malathi

  2. Dept. of Plastic Surgery, Cosmopolitan Hospital, Thiruvananthapuram, Kerala-695004, India

    Nandakumar Ulanat Ramkrishnan

  3. Dept. of Plastic Surgery, Bharath Hospital, , Kottayam, Kerala-686001, India

    Ajaikumar Kamath

Authors
  1. Fobin Varghese
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  2. Lekshmi Malathi
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  3. Nandakumar Ulanat Ramkrishnan
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  4. Ajaikumar Kamath
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by first and second authors. The first draft of the manuscript was written by first author, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lekshmi Malathi.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Government Medical College Kottayam (Date: 30 December 2021/No. 80/2021).

Consent for publication

The authors affirm that human research participants provided informed consent for sharing their data and publication of their images.

Conflict of interest

Fobin Varghese, Lekshmi Malathi, Nandakumar Ulanat Ramkrishnan, and Ajaikumar Kamath declare no competing interests.

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Varghese, F., Malathi, L., Ulanat Ramkrishnan, N. et al. A defensive approach to muscle flaps of the leg. Eur J Plast Surg 46, 811–816 (2023). https://doi.org/10.1007/s00238-023-02068-y

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  • DOI: https://doi.org/10.1007/s00238-023-02068-y

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