Stepladder V-Y advanced flaps based on the lateral calcaneal artery perforator for reconstruct the defects of lower-posterior heel
10.3760/cma.j.issn.1009-4598.2019.02.010
- VernacularTitle: 跟外侧动脉穿支阶梯状V-Y推进皮瓣修复足跟部中小创面
- Author:
Zeyong WU
1
;
Suijiang WANG
1
;
Haihua HUANG
1
;
Ping YAO
2
;
Yucang SHI
1
;
Xiaofang LI
3
;
Xiufeng CHEN
1
Author Information
1. Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
2. Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou 310014, China
3. Department of Pathology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China
- Publication Type:Clinical Trail
- Keywords:
Surgical flap;
Soft tissue injuries;
Perforator flap;
Lateral calcaneal artery
- From:
Chinese Journal of Plastic Surgery
2019;35(2):148-153
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the anatomy and clinical application of stepladder V-Y advanced flaps based on the lateral calcaneal artery perforator.
Methods:Twenty-four lower extremities from 12 adult cadavers were dissected to investigate the perforators emerging along the lateral edge of the achilles tendon, in terms of amount and distribution, relative to the tip of the lateral malleolus. Based on the anatomical findings, stepladder V-Y advanced flaps, based on the perforator(s) of the lateral calcaneal artery (LCA) or the peroneal artery (PA), were used for reconstruction of lower-posterior heel defects in 22 cases.
Results:Twenty-four lower extremities from 12 adult cadavers were successfully dissected. The peroneal artery continued to be the lateral calcaneal artery at the level of (6.0±1.4) cm above the tip of the lateral malleolus. Both of them have the perforators distributed to the skin in the achilles tendon area. In the space from the tip of the lateral malleolus to 8.0 cm and above, a total of 71 perforators with diameter larger than 0.5 mm were found in all extremities. Among them, 9%(7/71) were originated from peroneal artery, and 91%(64/71) were the lateral calcaneal artery. In the 22 cases of clinical application, the pedicle of flaps were used, based on the perforator of lateral calcaneal artery and (or) peroneal artery. The size of flaps ranged from 3.5 cm×9.0 cm to 5.0 cm×10.0 cm.There were 3 cases of skin necrosis at the tip of the flap, which were healed after dressing change. The other flaps had completely survived, and the wound healed in the first stage. Follow-up last for 8-24 months after operation. All patients had well recovery of ankle flexion, extension and appearance. They were able to weight-bearing walk, with natural gait. The texture and sensation of the flaps were similar to that of the surrounding skin. There were few obvious scar or contracture deformity. The functional recovery was satisfied.
Conclusions:The blood supply in the achilles tendon region is mainly from the lateral calcaneal artery, and partly from the peroneal artery. Stepladder V-Y advanced flap based on the lateral calcaneal artery perforator can be used with reliable blood supply and sensation reconstruction, which is a good choice to repair small to medial wounds in heel area.
