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Abdelrahman, Islam
Publications (10 of 15) Show all publications
Abdelrahman, I., Vieweg, R., Irschik, S., Steinvall, I., Sjöberg, F. & Elmasry, M. (2020). Development of delirium: Association with old age, severe burns, and intensive care. Burns, 46(4), 797-803
Open this publication in new window or tab >>Development of delirium: Association with old age, severe burns, and intensive care
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2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 4, p. 797-803Article in journal (Refereed) Published
Abstract [en]

Background Delirium is defined as a disturbance of attention and awareness that develops over a short period of time, is a change from the baseline, and typically fluctuates over time. Burn care involves a high prevalence of known risk factors for delirium such as sedation, inflammation, and prolonged stay in hospital. Our aim was to explore the extent of delirium and the impact of factors associated with it for adult patients who have been admitted to hospital with burns. Methods In this retrospective study, all adult patients who had been admitted with burns during a four-year period were studied, including both those who were treated with intensive care and intermediate care only (no intensive care). Daily records of the assessment of delirium using the Nursing Delirium Screening Scale (Nu-DESC) were analysed together with age, sex, the percentage of total body surface area burned, operations, and numbers of wound care procedures under anaesthesia, concentrations of plasma C-reactive protein, and other clinical variables. Logistic regression was used to analyse factors that were associated with delirium and its effect on mortality, and linear regression was used to analyse its effect on the duration of hospital stay. Results Fifty-one patients (19%) of the total 262 showed signs of delirium (Nu-DESC score of 2 or more) at least once during their stay in hospital. Signs of delirium were recorded in 42/89 patients (47%) who received intensive care, and in 9/173 (5%) who had intermediate care. Independent factors for delirium in the multivariable regression were: age over 74 years; number of operations and wound care procedures under anaesthesia; and the provision of intensive care (area under the curve 0.940, 95% CI 0.899–0.981). Duration of hospital stay, adjusted for age and burn size, was 13.2 (95% CI 7.4–18.9, p < 0.001) days longer in the group who had delirium. We found no independent effects of delirium on mortality. Conclusion We found a strong association between delirium and older age, provision ofr intensive care, and number of interventions under anaesthesia. A further 5% of patients who did not receive intensive care also showed signs of delirium, which is a finding that deserves to be thoroughly investigated in the future.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Burns, Delirium, Inflammation, Intensive care, Wound care procedures, Old age
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-164415 (URN)10.1016/j.burns.2020.02.013 (DOI)
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2020-06-04
Abdelrahman, I., Steinvall, I., Elmasry, M. & Sjöberg, F. (2020). Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial. Burns, 46(2), 465-471
Open this publication in new window or tab >>Lidocaine infusion has a 25% opioid-sparing effect on background pain after burns: A prospective, randomised, double-blind, controlled trial
2020 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 46, no 2, p. 465-471Article in journal (Refereed) Published
Abstract [en]

Background

The pain of a burn mainly results from the inflammatory cascade that is induced by the injured tissue, and is classified as background, breakthrough, procedural and postoperative pain. High doses of opioids are usually needed to treat background pain, so its management includes a combination of types of analgesia to reduce the side effects. Lidocaine given intravenously has been shown in two small, uncontrolled studies to have an appreciable effect on pain after burns.

Objectives

In this prospective double-blind controlled trial we aimed to examine and quantify the opioid-sparing effect of a continuous infusion of lidocaine for the treatment of background pain during the early period after a burn.

Methods

Adult patients injured with burns of >10 total body surface area burned (TBSA%) and treated with a morphine based patient-controlled analgesia device (PCA) were randomised to have either lidocaine infusion starting with a bolus dose (1 mg lidocaine/kg) followed by continuous infusion (180 mg lidocaine/hour) or a placebo infusion, for seven consecutive days. Total daily consumption of opioids (mg) and amount of pain (visual analogue score, VAS) were recorded.

Results

We included 19 patients, 10 of whom were given a lidocaine infusion. There were no differences between groups in VAS, TBSA%, time of enrolment to the study since the initial burn, or duration of hospital stay. The opioid consumption in the lidocaine group declined by roughly 25% during the period of the study.

Conclusion

An intravenous infusion of lidocaine was safe and had an opioid-sparing effect when treating background pain in burns.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Lidocaine infusion, Background pain, Burns, Opioid sparing effect, Randomized controlled trial
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-160128 (URN)10.1016/j.burns.2019.08.010 (DOI)000520838400028 ()31493952 (PubMedID)
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-09-06 Created: 2019-09-06 Last updated: 2020-04-08Bibliographically approved
Abdelrahman, I., Elmasry, M., Steinvall, I., Turesson, C., Sjöberg, F. & Hansson, T. (2020). Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study. Plastic and Reconstructive Surgery – Global Open, 8(1)
Open this publication in new window or tab >>Needle Fasciotomy or Collagenase Injection in the Treatment of Dupuytren’s Contracture: A Retrospective Study
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2020 (English)In: Plastic and Reconstructive Surgery – Global Open, E-ISSN 2169-7574, Vol. 8, no 1Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

Background: Dupuytren’s contracture is common among older people in Sweden. Previous studies comparing the treatment with an injection of collagenase with percutaneous needle fasciotomy found no differences. Methods: We retrospectively compared the degree of improvement in the deficit in extension of the joints in 2 groups of patients who had been treated with collagenase (71 fingers) or needle fasciotomy (109 fingers) before and 1 year after treatment. We compared the improvement of the extension deficit among the metacarpophalangeal (MCP) and proximal interphalangeal joints before and after the intervention; additionally, the level of improvement was classified into 3 levels (mild = 0° to 29°; moderate = 30° to 60°; considerable = 61° and more). Results: The degree of improvement of extension in the MCP joints was 11° greater in the collagenase group (P = 0.001). The number of patients who had an improvement of >60° (considerable) in extension was greater in the collagenase group (P = 0.02). Conclusion: Collagenase was more effective than needle fasciotomy in treating extension deficits of the MCP joints in Dupuytren’s contracture in this retrospective analysis. Further prospective studies are required to confirm the finding.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-163787 (URN)10.1097/GOX.0000000000002606 (DOI)
Available from: 2020-02-20 Created: 2020-02-20 Last updated: 2020-02-20
Wyckman, A., Abdelrahman, I., Steinvall, I., Zdolsek, J., Granfeldt, H., Sjöberg, F., . . . Elmasry, M. (2020). Reconstruction of sternal defects after sternotomy with postoperative osteomyelitis, using a unilateral pectoralis major advancement muscle flap. Scientific Reports, 10(1), Article ID 8380.
Open this publication in new window or tab >>Reconstruction of sternal defects after sternotomy with postoperative osteomyelitis, using a unilateral pectoralis major advancement muscle flap
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2020 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 10, no 1, article id 8380Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The pectoralis major flap, which is usually harvested bilaterally, is considered a workhorse flap in the reconstruction of sternal defects. After a median sternotomy for open heart surgery, 1%-3% of patients develop deep infection and dehiscence of the sternal wound, some of which will eventually require reconstructive surgery. Our aim was to describe the clinical feasibility and associated complications of the unilateral pectoralis major advancement flap in the reconstruction of sternal defects.

METHODS: A retrospective analysis of all adult patients who were operated on using a unilateral pectoralis major flap for reconstruction of the chest wall at the Linköping University Hospital during 2008-18 was made using data retrieved from medical records.

RESULTS: Forty-three patients had reconstructions with unilateral pectoralis major flaps. Three flaps failed completely, and another 10 patients developed complications that required further operation. The factors that were independently associated with loss of the flaps and complications were: older age, male sex, the number of different antibiotics used, and a long duration of treatment with negative wound pressure. Fewer wound revisions before the reconstruction resulted in more complications. The factors that were independently associated with prolonged time to complete healing were emergency reoperation after the initial operation and complications after reconstruction.

CONCLUSION: The unilateral pectoralis major advancement flap has proved to be a useful technique in the reconstruction of most sternal defects after sternal wound infection in older patients. There is, however, need for a follow-up study on a larger number of procedures to evaluate the long-term outcome compared with other methods of sternal reconstruction.

Place, publisher, year, edition, pages
Nature Publishing Group, 2020
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-165783 (URN)10.1038/s41598-020-65398-y (DOI)32433505 (PubMedID)2-s2.0-85085157668 (Scopus ID)
Available from: 2020-05-25 Created: 2020-05-25 Last updated: 2020-06-03Bibliographically approved
Abdelrahman, I., Steinvall, I., Fredrikson, M., Sjöberg, F. & Elmasry, M. (2019). Use of the burn intervention score to calculate the charges of the care of burns. Burns, 45(2), 303-309
Open this publication in new window or tab >>Use of the burn intervention score to calculate the charges of the care of burns
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 2, p. 303-309Article in journal (Refereed) Published
Abstract [en]

Background To our knowledge this is the first published estimate of the charges of the care of burns in Sweden. The Linköping Burn Interventional Score has been used to calculate the charges for each burned patient since 1993. The treatment of burns is versatile, and depends on the depth and extension of the burn. This requires a flexible system to detect the actual differences in the care provided. We aimed to describe the model of burn care that we used to calculate the charges incurred during the acute phase until discharge, so it could be reproduced and applied in other burn centres, which would facilitate a future objective comparison of the expenses in burn care. Methods All patients admitted with burns during the period 2010–15 were included. We analysed clinical and economic data from the daily burn scores during the acute phase of the burn until discharge from the burn centre. Results Total median charge/patient was US$ 28 199 (10th–90th centiles 4668-197 781) for 696 patients admitted. Burns caused by hot objects and electricity resulted in the highest charges/TBSA%, while charges/day were similar for the different causes of injury. Flame burns resulted in the highest mean charges/admission, probably because they had the longest duration of stay. Mean charges/patient increased in a linear fashion among the different age groups. Conclusion Our intervention-based estimate of charges has proved to be a valid tool that is sensitive to the procedures that drive the costs of the care of burns such as large TBSA%, intensive care, and operations. The burn score system could be reproduced easily in other burn centres worldwide and facilitate the comparison regardless of the differences in the currency and the economic circumstances.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Burns;Charges;Intervention score;Costs;Payments
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-153636 (URN)10.1016/j.burns.2018.12.007 (DOI)000461044900004 ()
Note

Funding agencies: Department of Hand Surgery, Plastic Surgery, and Burns; Linkoping University, Linkoping, Sweden

Available from: 2019-01-06 Created: 2019-01-06 Last updated: 2019-04-01
Pompermaier, L., Elmasry, M., Abdelrahman, I., Fredrikson, M., Sjöberg, F. & Steinvall, I. (2018). Are there any differences in the provided burn care between men and women? A retrospective study. Burns & Trauma, 6, Article ID 22.
Open this publication in new window or tab >>Are there any differences in the provided burn care between men and women? A retrospective study
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2018 (English)In: Burns & Trauma, E-ISSN 2321-3876, Vol. 6, article id 22Article in journal (Refereed) Published
Abstract [en]

Background

Disparity between medical treatment for men and women has been recorded worldwide. However, it is difficult to find out if the disparities in both the use of resources and outcome depend entirely on sex-related discrimination. Our aim was to investigate if there are differences in burn treatments between the sexes.

Methods

All patients admitted with burns to Linköping University Hospital during the 16-year period 2000–2015 were included. Interventions were prospectively recorded using the validated Burn SCoring system (BSC). Data were analysed using a multivariable panel regression model adjusted for age, percentage total body surface area (%TBSA), and in-hospital mortality.

Results

A total of 1363 patients were included, who generated a total of 22,301 daily recordings while they were inpatients. Males were 70% (930/1363). Sex was not an independent factor for daily scores after adjustment for age, %TBSA, and mortality in hospital (model R2=0.60, p < 0.001).

Conclusion

We found no evidence of inequity between the sexes in treatments given in our burn centre when we had adjusted for size of burn, age, and mortality. BSC seems to be an appropriate model in which to evaluate sex-related differences in the delivery of treatments.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Burn care; Intervention score; Sex; Trauma model; Workload
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-150365 (URN)10.1186/s41038-018-0125-0 (DOI)000442159400001 ()30123802 (PubMedID)
Available from: 2018-08-20 Created: 2018-08-20 Last updated: 2019-04-18Bibliographically approved
Abdelrahman, I., Steinvall, I., Mossaad, B., Sjöberg, F. & Elmasry, M. (2018). Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia. Aesthetic Plastic Surgery, 42(2), 1222-1230
Open this publication in new window or tab >>Evaluation of Glandular Liposculpture as a Single Treatment for Grades I and II Gynaecomastia
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2018 (English)In: Aesthetic Plastic Surgery, ISSN 0364-216X, E-ISSN 1432-5241, Vol. 42, no 2, p. 1222-1230Article in journal (Refereed) Published
Abstract [en]

Background

Gynaecomastia is a benign enlargement of the male breast, of which the psychological burden on the patient can be considerable, with the increased risk of disorders such as depression, anxiety, and social phobia. Minimal scarring can be achieved by liposuction alone, though it is known to have a limited effect on the dense glandular and fibroconnective tissues. We know of few studies published on “liposuction alone”, so we designed this study to evaluate the outcome of combining liposuction with glandular liposculpturing through two axillary incisions as a single treatment for the management of grades I and II gynaecomastia.

Methods

We made a retrospective analysis of 18 patients with grade I or II gynaecomastia who were operated on by combined liposuction and glandular liposculpturing using a fat disruptor cannula, without glandular excision, during the period 2014–2016. Patient satisfaction was assessed using the Breast Evaluation Questionnaire (BEQ), which is a 5-point Likert scale (1 = very dissatisfied; 2 = dissatisfied; 3 = neither; 4 = satisfied; 5 = very satisfied). The post-operative aesthetic appearance of the chest was evaluated by five independent observers on a scale from 1 to 5 (5 = considerable improvement).

Results

The patient mean (SD) overall satisfaction score was 4.7 (0.7), in which 92% of the responders were “satisfied” to “very satisfied”. The mean (SD) BEQ for all questions answered increased from 2.1 (0.2) “dissatisfied” preoperatively to 4.1 (0.2) “satisfied” post-operatively. The observers’ mean (SD) rate for the improvement in the shape of the front chest wall was 4.1 (0.7). No haematomas were recorded, one patient developed a wound infection, and two patients complained of remnants of tissue. The median (IQR) body mass index was 27.4 (26.7–29.4), 11 patients had gynaecomastia grade I, and 7 patients grade II. The median (IQR) volume of aspirated fat was 700 ml (650–800), operating time was 67 (65–75) minutes, 14 patients had general anaesthesia, and hospital charges were US$ 538 (481–594).

Conclusions

Combined liposuction and liposculpturing using the fat disruptor cannula resulted in satisfied patients and acceptable outcomes according to the observers’ ratings. It could be a useful alternative with an outcome that corresponds to that of more expensive methods.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Gynaecomastia, Liposculpture, Liposuction, Patient satisfaction
National Category
Surgery Gastroenterology and Hepatology Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-146046 (URN)10.1007/s00266-018-1118-x (DOI)000445156900007 ()29549405 (PubMedID)
Available from: 2018-03-23 Created: 2018-03-23 Last updated: 2019-04-18Bibliographically approved
Aboelnaga, A., Elmasry, M., Adly, O. A., Elbadawy, M. A., Abbas, A. H., Abdelrahman, I., . . . Steinvall, I. (2018). Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: A prospective, randomised, clinical trial. Burns, 44(8), 1982-1988
Open this publication in new window or tab >>Microbial cellulose dressing compared with silver sulphadiazine for the treatment of partial thickness burns: A prospective, randomised, clinical trial
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2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 44, no 8, p. 1982-1988Article in journal (Refereed) Published
Abstract [en]

Background

The current treatment for partial thickness burns at the trial site is silver sulphadiazine, as it minimises bacterial colonisation of wounds. Its deleterious effect on wound healing, together with the need for repeated, often painful, procedures, has brought about the search for a better treatment. Microbial cellulose has shown promising results that avoid these disadvantages. The aim of this study was therefore to compare microbial cellulose with silver sulphadiazine as a dressing for partial thickness burns.

Method

All patients who presented with partial thickness (superficial and deep dermal) burns from October 2014 to October 2016 were screened for this randomised clinical trial. Twenty patients were included in each group: the cellulose group was treated with microbial cellulose sheets and the control group with silver sulphadiazine cream 10 mg/g. The wound was evaluated every third day. Pain was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during and after each procedure. Other variables recorded were age, sex, percentage total body surface area burned (TBSA%), clinical signs of infection, time for epithelialisation and hospital stay. Linear multivariable regression was used to analyse the significance of differences between the treatment groups by adjusting for the size and depth of the burn, and the patient’s age.

Results

Median TBSA% was 9% (IQR 5.5–12.5). The median number of dressing changes was 1 (IQR 1–2) in the cellulose group, which was lower than that in the control group (median 9.5, IQR 6–16) (p < 0.001). Multivariable regression analysis showed that the group treated with microbial cellulose spent 6.3 (95% CI 0.2–12.5) fewer days in hospital (p = 0.04), had a mean score that was 3.4 (95% CI 2.5–4.3) points lower during wound care (p < 0.001), and 2.2 (95% CI 1.6–2.7) afterwards (p < 0.001). Epithelialisation was quicker, but not significantly so.

Conclusion

These results suggest that the microbial cellulose dressing is a better first choice for treatment of partial thickness burns than silver sulphadiazine cream. Fewer dressings of the wound were done and, combined with the low pain scores, this is good for both the patients and the health care system. The differences in randomisation of the area of burns is, however, a concern that needs to be included in the interpretation of the results.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-150103 (URN)10.1016/j.burns.2018.06.007 (DOI)000451331200015 ()30005989 (PubMedID)
Note

Funding agencies: Suez Canal University, Ismailia, Egypt

Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-12-13
Abdelrahman, I., Elmasry, M., Fredrikson, M. & Steinvall, I. (2018). Validation of the burn intervention score in a National Burn Centre. Burns (5), 1159-1166
Open this publication in new window or tab >>Validation of the burn intervention score in a National Burn Centre
2018 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, no 5, p. 1159-1166Article in journal (Refereed) Published
Abstract [en]

The Linköping burn score has been used for two decades to calculate the cost to the hospital of each burned patient. Our aim was to validate the Burn Score in a dedicated Burn Centre by analysing the associations with burn-specific factors: percentage of total body surface area burned (TBSA%), cause of injury, patients referred from other (non-specialist) centres, and survival, to find out which of these factors resulted in higher scores. Our second aim was to analyse the variation in scores of each category of care (surveillance, respiration, circulation, wound care, mobilisation, laboratory tests, infusions, and operation).

We made a retrospective analysis of all burned patients admitted during the period 2000–15. Multivariable regression models were used to analyse predictive factors for an increased daily burn score, the cumulative burn score (the sum of the daily burn scores for each patient) and the total burn score (total sum of burn scores for the whole group throughout the study period) in addition to sub-analysis of the different categories of care that make up the burn score.

We retrieved 22 301 daily recordings for inpatients. Mobilisation and care of the wound accounted for more than half of the total burn score during the study. Increased TBSA% and age over 45 years were associated with increased cumulative (model R2 0.43, p < 0.001) and daily (model R2 0.61, p < 0.001) burn scores. Patients who died had higher daily burn scores, while the cumulative burn score decreased with shorter duration of hospital stay (p < 0.001).

To our knowledge this is the first long term analysis and validation of a system for scoring burn interventions in patients with burns that explores its association with the factors important for outcome. Calculations of costs are based on the score, and it provides an indicator of the nurses’ workload. It also gives important information about the different dimensions of the care provided from thorough investigation of the scores for each category.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Burn intervention score; Validation; Workload
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-145311 (URN)10.1016/j.burns.2018.02.001 (DOI)000436791900014 ()29475745 (PubMedID)2-s2.0-85042192631 (Scopus ID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2018-07-23Bibliographically approved
Abdelrahman, I., Elmasry, M., Steinvall, I., Olofsson, P., Nettelblad, H. & Zdolsek, J. (2018). Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction. Plastic and Reconstructive Surgery – Global Open, 6(12), Article ID e2071.
Open this publication in new window or tab >>Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction
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2018 (English)In: Plastic and Reconstructive Surgery – Global Open, E-ISSN 2169-7574, Vol. 6, no 12, article id e2071Article in journal (Refereed) Published
Abstract [en]

Background: Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications. Methods: All adult patients who were operated with EDB flap reconstruction of the lower limb during 1997–2017 at the Department of Hand and Plastic Surgery, Linköping University Hospital, were included in this retrospective study. Results: Of 64 patients operated, only 7 had total flap failure, and the rate of complete success was 73% (47/64). Most of the skin defects were associated with fractures or complications thereof and were located in the ankle region, the dorsum of the foot, and the distal third of tibia or even the proximal tibia. Defects in the malleolar region and coexisting cardiovascular condition were factors associated with flap loss (either partial or total). Conclusion: The pedicled EDB-flap has, in our hands, proved to be a versatile and safe reconstructive option in the reconstruction of small defects in the lower leg and foot. Long-time follow-up is, however, recommended. 

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-153635 (URN)10.1097/GOX.0000000000002071 (DOI)
Available from: 2019-01-06 Created: 2019-01-06 Last updated: 2020-06-03
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