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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Locoregional Flaps in Lower Extremity Reconstruction.

¹Division of Plastic Surgery, University of California, Davis, 2335 Stockton Boulevard, Room 6008, Sacramento, CA 95817, USA.

Clinics in Plastic Surgery

|March 6, 2021

Summary

Locoregional flaps, including the medial hemisoleus and distally based sural artery flaps, offer effective soft tissue reconstruction for lower extremity wounds. These flaps are viable alternatives to free tissue transfer for less extensive distal leg injuries.

Keywords:

Limb salvage Local flap Lower extremity Reconstruction Regional flap Soft tissue

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Area of Science:

Orthopedics
Plastic Surgery
Reconstructive Surgery

Background:

Soft tissue reconstruction of the lower extremity is crucial for limb salvage and functional recovery.
Free tissue transfer has been a standard but invasive option for complex lower extremity defects.
Locoregional flaps present an alternative approach with unique advantages.

Purpose of the Study:

To evaluate the efficacy of locoregional flaps for lower extremity soft tissue reconstruction.
To highlight the medial hemisoleus muscle flap and distally based sural artery flap as preferred options.
To emphasize patient selection and surgical technique in achieving successful outcomes.

Main Methods:

Review of surgical techniques for elevating medial hemisoleus muscle flaps.
Analysis of dissection methods for distally based sural artery flaps.
Assessment of flap viability and outcomes in patients with lower extremity wounds.

Main Results:

Medial hemisoleus and distally based sural artery flaps are reliably elevated due to distinct vascular anatomy and advanced dissection.
These flaps can effectively replace free tissue transfer for less extensive wounds in the distal leg.
Successful reconstruction is contingent upon careful patient selection and mastery of flap dissection techniques.

Conclusions:

Locoregional flaps are an effective and important option for lower extremity soft tissue reconstruction.
The medial hemisoleus and distally based sural artery flaps are particularly suitable for distal leg defects.
Expertise in flap design and surgical execution is paramount for optimal reconstructive results.