The lateral supramalleolar perforator pedicle flap was optimized to repair the soft tissue defect of foot and ankle
10.3760/cma.j.cn114453-20200207-00030
- VernacularTitle:优化的外踝上皮瓣修复足踝部皮肤软组织缺损
- Author:
Junming LI
1
;
Yanhua LI
;
Hejun HUANG
;
Guanghui MA
;
Wei WANG
;
Xiaoguang ZHANG
Author Information
1. 漯河医学高等专科学校第二附属医院显微骨科 462300
- Keywords:
Surgical flaps;
Foot;
Ankle;
Reconstructive surgical procedures
- From:
Chinese Journal of Plastic Surgery
2021;37(2):171-177
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical effect of the optimized lateral supramalleolar perforator pedicle flap in repairing the soft tissue defect of the foot and ankle.Methods:From January 2016 to June 2019, the Microorthopaedics of the Second Affiliated Hospital of Luohe Medical College admitted 16 patients with small and medium area skin and soft tissue defects of the ankles, including 12 males and 4 females. The age ranged from 18 to 63, with an average age of 48. The defects was repaired with the optimized laterals uprmalleolus perforator pedicle flap. The width of the wound was measured preoperatively, and the anterolateral skin in the middle lower or middle part of the calf was evaluated by "lifting and kneading" according to the width of the wound. After the evaluation, the doner arear can be closed directly. The lateral supramalleolar perforating vessels and there proximal perforation of peroneal artery can be detected by Doppler ultrasound flowmeter. The line of two perforating points is used as the central axis of the flap. The rotation point of flap was at lateral malleolus plane or the superior edge of the inferior tibiofibular syndesmosis. The distance from the rotation point to the proximal edge of the wound was used as the pedicle length of the vsscular tissue. During the operation, the perforating branch in the pedicle of the flap and the descending branch in the terminal perforating branch of the peroneal artery should be protected. After the perforating vessels above the lateral supramalleolar perforating branch were clipped with vessel clips, the tourniquet was relaxed to evaluate the blood supply of the flap. If necessary, the interosseous membrane can be opened to carry the peronerl artery. The flap was transferred to the recipient area through the open channel which was optimized to cover the pedicle with a blunt curved or semicircular flap. In 4 patients with perimalleolar and plantar skin defects, the head end of the superficial peroneal nerve in the flap was anastomosed with the side of the recipient sural nerve. The donor area was closed directly. The survival of the flap was observed after operation.Results:In this group of 16 cases, the area of the flap was 3.0 cm×1.5 cm-14.0 cm×6.0 cm. Only 1 case of flap showed blood stasis and swelling at 24 h after surgery, with poor blood flow at the distal end. Although the pedicle suture was removed, one week later, the tip of the flap still showed small area of necrosis. After dressing changes later, it gradually heals. The other flaps survived without special treatment. 12 patients were followed up for 4 months to 2 years, and the flap shape and function were satisfactory. Among the 4 patients with nerve anastomosis, 3 of them were followed up for 8-13 months, 1 case recovered to grade S2, and 2 cases recovered to grade S3.Conclusions:Through the optimal selection of the flap donor area, the optimal design of the open channel, the evaluation of the blood supply of the flap and the optimal treatment of the perforating vessels, the survival rate of flap was not only improved, but also a good shape and function was obtained. Although some patients may have different degrees of sensory dysfunction of the dorsal foot after excision of the superficial peroneal nerve, it can still be regarded as one of the ideal method to repair the skin and soft tissue in the middle and small area of foot and ankle.
