Pseudoaneurysm of the anterior tibial artery is a rare cause of pain and swelling of the lower leg and the foot following minor sports injuries. When there is no definite musculoskeletal cause of pain, it is important to consider pseudoaneurysm. Early diagnosis and management are essential for the successful outcome. MRI and angiogram are useful for early diagnosis. We report a case of pseudoaneurysm of the anterior tibial artery following minor sports injury. The patient experienced complete relief of the symptoms after resection of the pseudoaneurysm.
Aneurysm, False* ; Athletic Injuries ; Early Diagnosis ; Foot ; Humans ; Leg ; Magnetic Resonance Imaging ; Tibial Arteries*

Preoperative angiography is frequently used in the planning of microsurgical reconstruction for identification of vascular abnormality that influence the planning of operation. But, recently 3D CT angiography is considered as new technique that can provide detailed information about vascular anatomy as well as soft and bony tissue without the risks of invasive angiography. 3D CT angiograms were performed in 19 patients before microsurgical reconstruction for the lower extremity and hand between May of 2003 and Oct of 2004. Sixteen of the studies were of the donor site and all of 19 studies were of the recipient site. No complications were found from the 3D CT angiograms. In one case of the bone exposed open wound, the injury of anterior tibial artery was identified and the zone of injury was adequately demonstrated. With the improvement in quality of CT imaging, 3D CT angiograms may provide a favorable alternative to invasive angiography. It is capable of providing high-resolution, three dimensional vascular imaging without the need for arterial puncture and prolonged post-procedure observation. The relation among blood vessels, bones, and soft tissue is well demonstrated in 3D CT angiogram. Also The acquisition time and examination cost were considerably lower in comparison with invasive angiography. In conclusion, this study demonstrates that 3D CT angiography may provide accurate, safe, and cost-effective preoperative imaging. The 3D CT angiography with relatively low morbidity, low cost, ease of image acquisition can have an broader role in microsurgical reconstructive surgery.
Angiography* ; Blood Vessels ; Hand ; Humans ; Lower Extremity ; Punctures ; Tibial Arteries ; Tissue Donors ; Wounds and Injuries

OBJECTIVE: To retrospectively evaluate the impact of pedal arch quality on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. MATERIALS AND METHODS: Between January 2014 and June 2015, 137 consecutive diabetic patients with foot wounds underwent infrainguinal endovascular revascularization (femoro-popliteal or below-the-knee, arteries). Postprocedural angiography of the foot was used to divide the patients into the following three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA). Time to healing and estimated 1-year outcomes in terms of freedom from minor amputation, limb salvage, and survival were evaluated and compared among the three groups. RESULTS: Postprocedural angiography showed the presence of a CPA in 42 patients (30.7%), IPA in 60 patients (43.8%), and APA in 35 patients (25.5%). Healing within 3 months from the procedure was achieved in 21 patients with CPA (50%), 17 patients with IPA (28.3%), and in 7 patients with APA (20%) (p = 0.01). There was a significant difference in terms of 1-year freedom from minor amputation among the three groups (CPA 84.1% vs. IPA 82.4% vs. APA 48.9%, p = 0.001). Estimated 1-year limb salvage was significantly better in patients with CPA (CPA 100% vs. IPA 93.8% vs. APA 70.1%, p < 0.001). Estimated 1-year survival was significantly better in patients with CPA (CPA 90% vs. IPA 80.8% vs. APA 62.7%, p = 0.004). CONCLUSION: Pedal arch status has a positive impact on time to healing, limb salvage, and survival in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization.
Amputation ; Angiography ; Diabetic Foot ; Foot ; Freedom ; Humans ; Limb Salvage ; Retrospective Studies ; Tibial Arteries ; Wounds and Injuries

PURPOSE: To investigate the arterial rupture, we evaluated the 15 victims of high tension injury. METHOD: The review included clinical course of injured limbs (entrance vs exit), site of spontaneous ruptures (subeschar: G1 vs zone of ischemia: G2), causes (spontaneous vs iatrogenic: G3, inflammatory vs associated thrombi), time and consequences of rupture (site of ligature, vascular manipulation). RESULT: 1) There were 18 spontaneous (G1, G2) and 4 iatrogenic ruptures (G3). 2) The G1 were 8 in 5 patients on the 19.6 +/- 8.1 (6-29)th post burn day: princeps pollicis/dorsalis indicis, dorsalis pollicis/superficial radial, radial, ulnar/radial and posterior tibial artery. The G2 were 10 in 8 patients on the 18.4 +/- 7.2 (9-31)th post burn day: brachial, ulnar, radial, ulnar/radial and branch/trunk of popliteal artery. 3) The G3 were superficial femoral/superficial femoral (at clamping site/anastomosis), subclavian (at clamping site) and princeps pollicis (at ligature) artery by inflammation 2-8 days after surgery. 4) The initial wound of limbs or fasciotomy cannot predict the possible ruptures. 5) The entrance had more ruptures than exit. 6) Five patients had multiple ruptures 1-13 days after first episode (3 at different, 2 at the same limb). 7) There was no difference of rupture time between G1 and G2. The G2 occurred at 2-7 cm apart from burn eschar. 8) Nine among 18 spontaneous ruptures were caused by inflammation. The rest 9 thrombotic ruptures occurred at the arterial wall over (2), at the margin (6) and 2 cm near (1) the thrombi. There was no time difference between inflammatory and thrombotic rupture [19.2 +/- 7.2 (9-31) vs 19.0 +/- 8.0 (6-29) days]. 9) There was no rupture after proximal 2-4 cm ligature at superficial arteries. The thrombi were formed finally in superficial femoral artery at 9 cm proximal to the rupture site. CONCLUSION: We recommend that timely decision to amputate must be made to reduce spontaneous ruptures. Also careful attention should be paid to select the safe distance, at least 10 cm in deep arterial injures, in vascular procedures.
Arteries* ; Burns* ; Constriction ; Extremities ; Femoral Artery ; Humans ; Inflammation ; Ischemia ; Ligation ; Popliteal Artery ; Rupture* ; Rupture, Spontaneous ; Tibial Arteries ; Wounds and Injuries

OBJECTIVETo study a new method of the vascularized plantaris tendon transferring.

METHODSThe vascularized plantaris tendon was elevated with the pedicle of the fascial perforating vessel or a small segment of the posterior tibial artery, which was transplanted to the wrist to repair the tendon defects of the flexor pollicis longus or the flexor digitorum muscle resulted from electric injury. According to the defects, the plantaris tendon can be used together with the skin, fascia, or both as a composite flap. 7 cases received the operation with complete survival of the flap.

RESULTSPostoperative follow-up showed satisfactory results in the 7 cases. Through physical exercises, the patients obtained increased joint motion and better function of the hand.

CONCLUSIONThe vascularized plantaris tendon has many advantages, including easy to harvest, easy to plerosis the donor site, little affect to a main vessel, able to repair the complex defects. This method has great potential for applications.

Electric Injuries ; surgery ; Fascia ; Foot ; Hand Injuries ; surgery ; Humans ; Surgical Flaps ; blood supply ; transplantation ; Tendons ; blood supply ; transplantation ; Tibial Arteries ; Transplants ; Wrist Injuries ; etiology ; surgery

Objective: To explore the clinical effects of free superficial peroneal artery perforator flaps in repairing skin and soft tissue defects of the hallux. Methods: A retrospective observational study was conducted. From January 2020 to January 2021, 13 patients with skin and soft tissue defects of the hallux who met the inclusion criteria were admitted to Department of Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 12 males and 1 female, aged 26 to 53 years. Before operation, the perforating point of the superficial peroneal artery perforator was located by color Doppler ultrasound on the calf on the same side of the affected hallux and marked on the body surface. The operation was performed under spinal anesthesia combined with continuous epidural anesthesia. The area of skin and soft tissue defect after debridement was 4.5 cm×2.5 cm to 12.0 cm×3.0 cm. According to the size and shape of the wound, the superficial peroneal artery perforator flap was designed with the line between the fibular head and the lateral malleolus tip parallel shifting 2 cm to the tibial side as the flap axis line, and the perforating point of the perforator near the midpoint of the axis line as the center. The cut area of the flap was 5.0 cm×3.0 cm to 13.0 cm×4.0 cm, and part of the deep fascia was cut when the pedicle was freed. The donor site wound was sutured directly. During the operation, the number and type of the perforator and the cutting time of the flap were recorded, and the length of the perforator pedicle and diameter of the perforator were measured. The survival of the flap, the healing time and the healing condition of the donor and recipient areas were recorded after operation. The color, texture, elasticity of the flap, standing and walking functions of patients, the recovery of the donor area, and the patients' satisfaction with the recovery of the donor and recipient areas were recorded during the follow-up. At the last follow-up, the sensation of the flap was evaluated by the British Medical Association sensory function evaluation standard, the function of the affected limb was evaluated by the American Society of Foot and Ankle Surgery scoring system, and the excellent and good rate of the function of the affected limb was calculated. Results: A total of 13 perforators of the superficial peroneal artery were detected during the operation, all of which were septocutaneous perforators, and the perforator diameter was 0.3 to 0.5 mm. The vascular pedicle length was 2 to 5 cm. Flap cutting time was 11 to 26 minutes. The flaps of 13 patients all survived completely. The wounds at the donor and recipient sites healed well 9 to 18 days after operation. During follow-up of 6 to 14 months, the flaps had good color, texture, and elasticity; 11 patients had no obvious bloated appearance, and the other 2 patients underwent flap thinning and plastic surgery in the second stage because of their bloated appearance; all the patients returned to normal walking and standing functions. There was only one linear scar left in the donor site, with no obvious scar hyperplasia or hyperpigmentation. All the patients were satisfied with the recovery of the donor and recipient areas. At the last follow-up, the sensation of the flap was evaluated as grade S₃ in 2 cases, grade S₂ in 9 cases, and grade S₁ in 2 cases; the function of the affected limb was evaluated as excellent in 7 cases and good in 6 cases, with an excellent and good rate of 100%. Conclusions: The free superficial peroneal artery perforator flap has relatively constant vascular anatomy, which is thin and wear-resistant, with less damage to the donor site after flap excision, and can preserve the shape and function of the hallux to the greatest extent. It is an effective method for repairing skin and soft tissue defect of the hallux.
Cicatrix ; Female ; Hallux/surgery* ; Humans ; Lower Extremity ; Male ; Perforator Flap/blood supply* ; Soft Tissue Injuries/surgery* ; Tibial Arteries/surgery*

PURPOSE: The coverage of distal soft tissue defects and bony exposure of the lower extremity has long been recognized to be difficult clinical problem. Covering with a local skin flap is usually impractical because of the extensive and deep crush, hence free flap has been used commonly for the coverage of the wound. Although it can provide good results, it has many disadvantages. Designing an adipofascial flap raised on perforating vessels of the posterior tibia artery is a reliable and simple method to perform, and it can solve these problems. METHODS: From May 2005 to May 2006, 8 patients underwent reconstruction of lower leg defects utilizing various type of the posterior tibial artery perforator adipofascial flaps. The flap provided a durable and thin coverage for the defect, as well as a well vascularized bed for skin grafting. RESULTS: The flap size ranged 15-80cm(2), and skin graft was done for the recipient site. The flap were successfully used for the lower extremity reconstruction in most cases. Minor complications occurred in 4 cases. There was no functional disability of the donor site with esthetically pleasing results. Furthermore, these flaps were both easy to raise and insured sufficient arterial blood supply. CONCLUSION: We believe there are many advantages to this posterior tibial artery perforator adipofascial flap and that it can be highly competitive to the free flaps in the lower extremity reconstruction.
Arteries ; Free Tissue Flaps ; Humans ; Leg* ; Lower Extremity ; Perforator Flap ; Skin ; Skin Transplantation ; Tibia ; Tibial Arteries ; Tissue Donors ; Transplants ; Wounds and Injuries

The coverage of soft tissue defects around the knee joint or upper one third of lower leg presents a difficult challenge to the reconstructive surgeon. Various reconstructive choices are available depending on the location, size and depth of the defect. The authors present their clinical application of a medial sural artery perforator island flap as a useful alternative method for upper one third of lower leg and knee reconstruction. From 2002 to 2004, we operated total 4 patients (total 4 flaps) using the medial sural artey perforator island flap for coverage of the defect on upper one third of lower leg and knee, of 4 patients, 3 patients was men and one was woman. Average patient age was 54.6 years. The largest flap obtained was 10x8cm2. Postoperative follow up of the patients ranged from two to 33 months. In two cases, defects was located on upper one third of lower leg and in other two cases, defects were on the knee. All four cases had bone exposure open wound. In angiography, 2 cases had injured in the anterior tibial artery, 1 case had injured in the posterior tibial artery. There were no diabetes or other vascular disease. All 4 flaps were survived completely, without minor complications such as venous congestion and hematoma. Donor morbidity was restricted substantially to the donor linear scar. There were no functional impairment. As the main advantages of the medial sural perforator island flap, it ensures constant location and reliable blood supply without sacrificing any main source artery or damaging underlying muscle. This procedure is valuable extension of local flap for defect coverage with minimal functional deficit donor site and good aesthetic result on the defect. We consider it as one of the useful methods of the upper one third of lower leg and knee reconstruction.
Angiography ; Arteries ; Cicatrix ; Female ; Follow-Up Studies ; Hematoma ; Humans ; Hyperemia ; Knee Joint ; Knee* ; Leg* ; Lower Extremity ; Male ; Tibial Arteries ; Tissue Donors ; Vascular Diseases ; Wounds and Injuries

OBJECTIVETo explore the clinical effect of plantar medial perforator artery based reverse island medial dorsal pedal neurocutaneous vascular flaps.

METHODS12 cases with soft tissue defects of forefeet were treated by plantar medial perforator artery based reverse island medial dorsal pedal neurocutaneous vascular flaps. The flap size ranged from 3.0 cm x 3.5 cm to 5.5 cm x 8.5 cm.

RESULTAll flaps survived completely. The patients were followed up for 6 - 24 months. The texture and flexibility of the flaps were normal with no ulcer. The sensation improved with the two-point discrimination of 7 - 10 mm. The cosmetic and functional results were satisfactory. The wounds at donor site healed primarily.

CONCLUSIONSThe flaps have expanded size for large defects with good flexibility, thickness and texture. It is easily performed with less morbidity to main artery.

Adult ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; innervation ; Tibial Arteries ; surgery ; Young Adult

OBJECTIVETo investigate the therapeutic effect of V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus for small skin defect on children heel.

METHODSFrom Mar. 2012 to Jan. 2014, 9 children with small skin defects on heel were treated with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus. The flaps were 8.0 cm x 4.0 cm to 9.0 cm x 4.5 cm in size and the wounds at donor sits were directly closed.

RESULTSAll flaps survived completely with primary healing. 9 cases were followed up for 6-12 months( average, 9 months). The flaps had good match with surrounding tissue in texture and color. The function of ankle was normal. All the parents were satisfied with functional and cosmetic results.

CONCLUSIONSIt is a safe and practical method for treatment of small skin defect on children heel with adjacent V-Y advanced flap pedicled with perforator of peroneal artery at posterior lateral malleolus.

Ankle ; Child ; Fibula ; Heel ; injuries ; Humans ; Perforator Flap ; blood supply ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; Skin Transplantation ; Tibial Arteries ; Wound Healing