Optimal Timing and Duration of Flap-Frame Immobilization: A Podoplastic Case Series

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Podiatric Surgery

Background:

• Flap-based and podoplastic limb salvage in the foot and ankle is challenging due to biomechanical forces impacting healing.
• External fixation is crucial for immobilizing flaps, neutralizing forces, and promoting optimal healing.
• The optimal duration and timing of external fixation for flap immobilization remain unclear.

Purpose of the Study:

• To evaluate complication and limb salvage rates in patients undergoing flap-based limb salvage with external fixation.
• To determine the impact of external fixation duration and timing on outcomes.

Main Methods:

• Retrospective analysis of 18 patients who underwent flap-frame immobilization using a multiplanar external fixator.
• Data collected included complication rates, limb salvage rates, and follow-up duration.

Main Results:

• A limb salvage rate of 66.7% was achieved with a mean follow-up of 2.4 years.
• The majority of patients (88.9%) had diabetes mellitus, with a mean defect size of 110.9 cm2.
• Minor flap complications occurred in 38.9% of patients, necessitating reoperation.

Conclusions:

• External fixation is essential for successful flap-based limb salvage.
• An immobilization duration of approximately 28 to 35 days may represent an optimal "Goldilocks zone".
• Factors like open amputation, larger defect size, and Charcot's neuroarthropathy negatively affect limb salvage rates irrespective of fixation duration.