When to Consider Flap Reconstruction for a Non-Healing Wound

It might surprise you to learn that nearly 2.5% of the overall population in the United States is affected by chronic wounds, including 10.5 million Medicare beneficiaries. Though these numbers may not be so surprising if you consider that tens of millions of Americans are at risk for slow-healing foot, ankle, and leg wounds thanks to common conditions like diabetes and peripheral artery disease (foot ulcers develop in up to 34% of patients with diabetes alone).

When it comes to treating these chronic wounds, board-certified podiatric surgeon Dr. Thomas Rambacher and the team at Foot Ankle Leg Wound Care Orange County aren’t without solutions. Here, we look at one great treatment for promoting healing in problematic foot and leg ulcers — flap reconstruction — to determine whether it’s an avenue worth exploring for your situation.

Treating lower leg ulcers

When we talk about slow-healing, non-healing, and chronic wounds, they’re all referring to the same thing — wounds or ulcers that don’t follow a timely healing process. Instead, they stall due to lack of access to healing resources, namely oxygen and blood.

This pause in healing typically happens while the wound is still open, which allows harmful bacteria to get in and infection to develop. Playing this out even further, the infection can spread, which can lead to gangrene and amputation.

Now let’s walk this back in the other direction to show how we avoid this life-changing outcome. When we first encounter a problematic wound, we prefer to start out conservatively with:

• Prescription wound care products
• Strong antibiotics
• Debridement (we clear away infected tissue)
• Relieving pressure on the wound

If we catch the wound early enough, these more conservative efforts can often be highly effective in getting the wound healing back on track, though not always. If the wound doesn't respond, then we need to get more aggressive, which might include flap reconstruction.

Flap reconstruction: Getting resources in

One of the tools we use to help wounds heal is skin grafting to introduce healthier tissues. Flap reconstruction is a form of this with one key difference: we use tissues from your own body and preserve their own blood supply.

A flap not only includes its own blood supply, we may also use muscle, fat, connective tissues, and bone from the donor site, depending upon how large your wound is.

There are two types of flaps that we can use for lower leg, ankle, and foot ulcers that aren’t healing:

1. Local flap

With a local flap, we take a healthy piece of neighboring tissue and reposition it over your wound. In using local tissue, we’re able to keep at least one blood vessel connected so that resources can find their way more easily to the new location.

2. Free flap

If there’s no tissue available close to your non-healing wound, we can harvest healthy tissue from somewhere else in your body. When we do that, we have to perform microsurgery to connect the blood vessels in the donor tissue to the ones at the new site.

In either case, the goal of flap reconstruction, which is also called orthoplastic surgery, is to introduce healthy, viable tissue that can help your wound turn the corner and heal up.

Who’s a good candidate for flap reconstruction

As we’ve already mentioned, flap reconstruction is a good option if conservative efforts fail to jump-start stalled wound healing.

We should also mention that flap reconstruction requires patience. You'll likely be non-weight-bearing for several weeks, if not months, to allow time and space for the flap to take hold.

Additionally, your health should be good enough that you can undergo a procedure like this as we may need to use general anesthesia.

Really, the best way to figure out whether you should be considering flap reconstruction is to come see us for a comprehensive evaluation of your non-healing wound. To get that ball rolling, please call our office in Mission Viejo, California, at 949-832-6018 or request an appointment online today.