The reverse saphenous nerve neurocutaneous flaps for reparing skin defects of forefoot with the help of three-dimensional computerized tomography angiography
10.3760/cma.j.issn.1009-4598.2020.02.012
- VernacularTitle:三维CT血管造影辅助设计足内侧隐神经营养血管皮瓣修复足远端软组织缺损
- Author:
Jinlan DOU
1
;
Zhenxin TIAN
;
Shanshan ZHENG
;
Yong SHANG
;
Yuejie XU
;
Zhihang ZHOU
;
Guangcheng ZHENG
;
Kewei SONG
;
Feifei CHEN
Author Information
1. 山东省潍坊市益都中心医院手足外科 262500
- Keywords:
Three-dimensional reconstruction;
Computer tomographic angiography;
Surgical flaps;
Saphenous neuro-fasciocutaneous flap;
Foot;
Defect
- From:
Chinese Journal of Plastic Surgery
2020;36(2):175-179
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot with the help of the three dimensional computerized tomography angiography(3D-CTA).Methods:From November 2013 to February 2018, 19 patients with anterior foot defects were treated in the Yidu Central Hospital of Weifang. There were 12 males and 7 females. The patients ranged from 16 to 45 years old, with an average age of 29.6 years. Preoperative 3D-CTA examination of the ipsilateral foot was performed to find out the blood vessels in the donor site, to determine the location, course, length of the superficial branch of the medial plantar toe artery and its relationship with the surrounding tissues, and to design the medial saphenous nerve nutrient vessel skin flap for retrograde repair of the skin and soft tissue defect at the front of the foot. Sensitive recovery were evaluated according to Swanson evaluation of clinical effect of peripheral nervous impairment.Results:Preoperative three-dimensional CT angiography showed that the superficial branches of the medial plantar toe artery were detected, and the perforating vessels during the operation were basically consistent according to the result of the examination. The 19 cases of forefeet skin detects were successfully reconstructed with the reverse saphenous nerve neurocutaneous flaps. All patients were followed up with the mean of 8 months. All flaps survived totally without diabrosis and swelling. The walking and weight-bearing were normal and the blood supply of foot were good. The functional recovery of foot and ankle was excellent in 8 cases, good in 10 cases and middle in 1 case. The sensory recovery of the forefoot: S4 5 feet, S3 10 feet, S2 4 feet; R4 3 feet, R3 9 feet, R2 7 feet.Conclusions:Preoperative 3D-CTA examination can confirm the anatomy of the superficial branch of the medial toe base artery in the donor site and guide the design of the medial saphenous nerve nutrient vessel flap for retrograde repair of skin and soft tissue defects of the distal foot. The blood supply is reliable, the wound is small and the effect is satisfactory.
