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Original Article Plastic and Aesthetic Research

Hyperbaric oxygen therapy and surgical

delay improve flap survival of reverse

pedicle flaps for lower third leg and foot

reconstruction

Pradeoth Mukundan Korambayil, Prashanth Varkey Ambookan
Department of Plastic Surgery and Burns, Jubilee Institute of Surgery for Hand, Aesthetic and Microsurgery, Jubilee Mission Medical
College and Research Institute, Thrissur 680005, Kerala, India.
Address for correspondence: Dr. Pradeoth Mukundan Korambayil, Department of Plastic Surgery and Burns, Jubilee Institute of Surgery for Hand,
Aesthetic and Microsurgery, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India. E-mail: pradeoth@gmail.com

ABSTRACT
Aim: The purpose of the study is to present a management protocol for various types of soft tissue
defects of the distal third region of leg and foot treated with pedicle flaps, by including hyperbaric
oxygen (HBO) therapy in the treatment regimen with flap delay. Methods: We present a prospective
study of 23 patients with various types of soft tissue defects of the foot, and lower third of leg managed
in our institution from December 2012 to December 2013. All soft tissue defects were treated by a
reverse pedicle flap. Twelve patients were managed with flap delay with HBO therapy and 11 patients
with immediate flaps without HBO therapy. The postoperative period, hospital course, and follow-up
were documented. Results: Of 12 patients with flap delay and HBO, 10 patients did not suffer any
complications secondary to flap transfer. One patient had discoloration of the tip of the flap, which
settled without the intervention, and 1 patient had recurrent abscess formation, which required
debridement and closure. Of 11 patients with direct transfer, 6 patients presented with complications
including flap congestion, partial flap loss, and tip necrosis, which required secondary intervention.
Conclusion: HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue
reconstruction of the lower third of the leg and foot regions.

Key words:
Flap delay, hyperbaric oxygen therapy, reverse pedicle flap, soft tissue reconstruction

INTRODUCTION the lower third of the leg and foot regions. The lateral
supramalleolar flap [1,2] from the lateral aspect of the lower
Although numerous techniques ranging from skin leg, and the flap supplied by a perforating branch of the
grafting to free-tissue transfer have been utilized for dorsal peroneal artery are commonly used for coverage of
reconstruction of soft tissue defects of the foot, and the dorsum of the foot, the medial and lateral arches, and
lower third of the leg regions, very few have yielded all regions of the heel. The reverse sural flap [3,4] is raised
entirely satisfactory results. A safe, easy and reliable from the posterior aspect of the calf and is commonly
reconstructive option is required for reconstruction of used for coverage of the hind foot, dorsum, and the
lateral malleolus. Distally-based flaps based on the
Access this article online posterior tibial artery or the peroneal artery perforator
[5]
Quick Response Code: plus flap also assist in the soft tissue coverage of
Website: defects of the distal third of the leg. In this prospective
www.parjournal.net
study, 23 patients were treated with distally-based pedicle
flap coverage in which 12 patients underwent flap delay
DOI: with hyperbaric oxygen (HBO) therapy, and 11 patients
10.4103/2347-9264.157107 underwent immediate flap transfer without HBO therapy.
The study was undertaken prospectively over a period of

130 Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015