1. Soft Tissue Reconstruction:
Orthoplastic Approach
Suresh Pandey
Professor and Head, Dept. of Orthopedics, COMS
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
2. Contents
• Rationale and problem magnitude
• Our Study
• Illustration and Techniques
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
8. What is Orthoplastic Approach
• Addressing bone and soft tissue problems simultaneously on priority
basis
• Aim is to minimize complications and achieve better functional results
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
9. Why soft tissue management important
• Remember AO Principle
• Minimize soft tissue and bony complication
• Reduces infection, morbidity, repeated surgery and amputation
Soft Tissue and Bony defect: Orthoplastic Approach ICL Chitwan
2022.01.10
10. Approach
• Role of lavage and early debridement
• Decision making in high velocity injury
• Assess vascularity
• Limb salvage Vs Amputation
Soft Tissue and Bony defect: Orthoplastic Approach ICL Chitwan
2022.01.10
11. Why Orthoplastic approach?
• Ever rise in high velocity injury esp RTA
• Increasing higher grade of injury
• Increased prosthesis and implant related complications
• Increased Infection related complications
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
12. Our Experience
• Retrospective case series of 2 years
• At least 3 mth FU
• Total Orthopalstics 104
• UL: 36
• LL and pelvis: 68
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
13. • Mean Age: 26 yrs with range 17-56
• M:F=85:19
• Pelvis: 6
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
14. Leg and knee Flap Types and patient number
• Knee and proximal third: Med Gastroc (18)
• Middle third: Soleus (9)
• Distal 3rd: Reverse sural (29)
• Pelvis: 6
• Thigh: 3
• Groin Flap: 3
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
18, 27%
9, 13%
28, 42%
6, 9%
3, 5% 3, 4%
Sites
Knee Midleg Distal 3rd Pelvis Thigh Groin
15. Etiology
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
0
10
20
30
40
50
60
Traumatic Infective Fracture
Cause Distribution
Series 1 Column1 Column2
56
49
16. Results
• All the flap healed completely except one sural flap
• ROM near normal
• Cosmesis acceptable
• No infection, neurological deficit.
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
25. Heel loss with medial malleolus fracture
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
26. BB fracture with tissue loss
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
27. Traumatic crush injury with worse wound
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
28. Infection with soft tissue loss with DFU
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
29. Trophic ulcer with infection and exposed
calcaneum with COM calc.
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
30. TA transection, exposed, length loss, infection
and soft tissue loss with bimalleolar fracture
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
31. Bosworth technique for TA n sural flap for
coverage
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
32. Venous ulcer non-healing for 5 years with
failed repeated attempt
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
41. The Soleus Muscle Flap An
Overview of Its Clinical Applications
for Lower Extremity Reconstruction
Song, Ping MD; Pu, Lee L. Q. MD, PhD, FACS
Annals of Plastic Surgery: December 2018 - Volume 81 -
Issue 6S - p S109-S116
doi: 10.1097/SAP.0000000000001499
We show that the medial hemisoleus muscle flap is a
reliable local option, both by itself or in conjunction with
other local flaps, to reconstruct less extensive wounds in
the middle to distal third of the leg.
Journal of Wound CareVol. 22, No. 11Practice
Hemisoleus muscle flap in the reconstruction of exposed bones
in the lower limb
Ahmad , S. Akhtar , E. Rashidi , M. F. Khurram
Due to a high degree of reliability, versatility, minimal donor site
morbidity, less operating time, low cost and good functional gain,
this procedure is highly suitable for the treatment of complex
middle and lower leg defects.
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
Effect of medial hemisoleus muscle flap on wound healing in
the medial and distal thirds of the lower leg
Rev. Bras. Cir. Plást. 2018;33(4):501-510
Conclusions: The medial hemisoleus flap is useful for repairing substance
loss and provides coverage with intermediary thickened tissue, high
vascularity, minimal donor-site morbidity, foot plantar flexion power
preservation, faster rehabilitation, accessible surgical techniques, and a
shorter operative time.
42. Prox 3rd and knee: Med Gastroc.
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
43. Med Gastroc flap type V tibial plateau
Soft Tissue and Bony defect: Orthoplastic Approach ICL Chitwan
2022.01.10
44. Knee and patellar tendon exposed
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
45. Chronic OM with exposed tibia
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
48. Exposed popliteal vessels and tibial nerve
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
49. Evidences/Literatures
RECONSTRUCTIVE: LOWER EXTREMITY: ORIGINAL ARTICLES
The Pedicled Gastrocnemius Muscle
Flap: A Review of 218 Cases
Daigeler, Adrien M.D.; Drücke, Daniel M.D.; Tatar, Karl M.S.; Homann, Heinz-
Herbert M.D.; Goertz, Ole M.D.; Tilkorn, Daniel M.D.; Lehnhardt, Marcus M.D.;
Steinau, Hans-Ulrich M.D.
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
Gastrocnemius muscle transfer represents a safe
and simple procedure in the treatment of lower
leg defects and in limb preservation
World J Plast Surg. 2018 Sep; 7(3): 314–318.
doi: 10.29252/wjps.7.3.314
PMCID: PMC6290304
PMID: 30560070
Gastrocnemius Myocutaneous Flap: A Versatile Option to Cover the
Defect of Upper and Middle Third Leg
Jagdeep Rao,1 Rakesh Tawar,2 and Rakesh Dawar1,*
Post-traumatic large defects of leg extending in upper and middle third
were easily covered with the help of regional gastrocnemius myocutaneous
flap with excellent outcome and aesthetically acceptable coverage of skin
without any major complications or long term morbidity.
50. Type V tibial plateaue with infn with exposed
bone and patellar tendon
Soft Tissue and Bony defect: Orthoplastic Approach ICL Chitwan
2022.01.10
53. Trochanteric region sequelae of Morrale
Lavale: TFL flap
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
54. Pelvis fracture with pressure sore: Gluteal
rotn flap
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
55. Take Home Message
• Knowledge of anatomy and surface marking important
• Early decision and intervention better
• Emphasis on meticulous debridement and infection control
• Address fracture
• Remember constraint set up
• Sweat and Toils from your side and patience from patient’s side are
keys to success
ICL ORTHOCON 2022 Chitwan, Orthoplastic Approach to
Reconstruction
