Experience in Flap Reconstruction of Lower Limb Defects in a Tertiary Care Center of Nepal

Authors

  • Himalaya Niraula Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Bikesh Rajbhandari Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Manish Devkota Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Samit Sharma Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Sangam Rayamajhi Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Jayan M Shrestha Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
  • Ishwar Lohani Department of Plastic Surgery and Burns, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal

Keywords:

Lower limb reconstruction, pressure ulcers, reverse sural artery flap

Abstract

Introduction
Lower limb defects are caused by trauma, chronic ulcers or oncological resection. Being a large and varied area of the body, lower limb reconstruction is challenging. This study analyzed clinical presentation of such defects, surgical management and outcomes in Nepalese context.

Methods
Single-center retrospective study of flap reconstruction of lower limb defects conducted in Tribhuvan University Teaching Hospital, Kathmandu over a two years period (April 2019-March 2021). Demographics, clinical presentation, comorbidities, treatment and complications were recorded and analyzed.

Results
A total of 53 flaps were performed on 47 patients with 50 defects (35 males and 12 females). Road traffic accidents (38.3%) and pressure ulcers (17.02%) were common causes. Ankle-foot was the most affected site (48%), followed by leg and thigh (18% each). Defect size ranged from 3 cm2 to 396 cm2. Surgery consisted of 46 pedicled and seven free flaps. Reverse sural artery flap was the commonest flap performed (30.2%). All free flaps were performed on defects larger than 100cm2. Overall complication rate was 30.2%, partial flap loss being the commonest (15.1%). Total flap loss occurred in one pedicled and one free flap. Eleven pressure ulcers were operated on, with 36.4% complication rate. Average hospital stay was 33.5±26.88 days.

Conclusion
Multiple surgeries, comorbidities and high complication rates with hospital stay of more than a month reflect the difficulties encountered in lower limb reconstruction. Despite these challenges, majority of our patients were discharged with stable wound coverage.

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Published

2021-12-31

How to Cite

Niraula, H., Rajbhandari, B., Devkota, M., Sharma, S., Rayamajhi, S., Shrestha, J. M., & Lohani, I. (2021). Experience in Flap Reconstruction of Lower Limb Defects in a Tertiary Care Center of Nepal. Journal of Institute of Medicine Nepal, 43(3), 30–34. Retrieved from http://www.jiomnepal.com.np/index.php/jiomnepal/article/view/184