J Reconstr Microsurg 2016; 32(02): 101-108
DOI: 10.1055/s-0035-1558986
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Striving for Normalcy after Lower Extremity Reconstruction with Free Tissue: The Role of Secondary Esthetic Refinements

Jonas A. Nelson
1   Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
John P. Fischer
1   Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Nicholas T. Haddock
2   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Duncan Mackay
1   Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Jason D. Wink
1   Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Andrew S. Newman
3   Division of Plastic Surgery, Temple University Hospital, Philadelphia, Pennsylvania
,
L. Scott Levin
4   Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
,
Stephen J. Kovach
1   Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

10 February 2015

11 June 2015

Publication Date:
10 August 2015 (online)

Abstract

Background Many patients with successful lower extremity salvage have postoperative functional and esthetic concerns. Such concerns range from contour irregularity preventing proper shoe-fitting to esthetic concerns involving color, contour, and texture match. The purpose of this study is to determine the overall incidence as well as factors associated with an increased likelihood of undergoing secondary, esthetic refinements of lower extremity free flaps and to review current revision techniques.

Methods All patients undergoing lower extremity soft tissue coverage for limb salvage procedures between January 2007 and June 2013 at a single institution were included in the analysis. Patients who underwent secondary refinements for lower extremity free flaps were compared with patients not undergoing secondary procedures.

Results During the study period, 152 patients underwent reconstruction and were eligible for inclusion. Of these, 32 (21.1%) patients underwent secondary, esthetic revisions. Few differences in patient or case characteristics were noted, although revision patients trended toward being younger, having lower body mass index, with defects secondary to acute trauma located below the ankle. The most common revision was complex soft tissue rearrangement or surgical flap debulking/direct excision (87.5% of patients), followed by scar revision (12.5%), suction-assisted lipectomy (3.1%), laser scar revision (3.1%), and tissue expansion with local tissue rearrangement (3.1%).

Conclusion A significant portion of patients desire secondary revisions following the initial procedure. This is especially true of younger patients with below ankle reconstruction. In many patients, an esthetic consideration should not be of secondary concern, but should be part of the ultimate reconstructive algorithm for lower extremity limb salvage.

 
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