OBJECTIVE: To evaluate the effectiveness of tibial nerve transection with epineurial suture and division of the common plantar digital nerve branches in the treatment of congenital macrodactyly in children. METHODS: A retrospective analysis was conducted on clinical data from 9 children with congenital macrodactyly who met the selection criteria and were admitted between January 2018 and December 2024. The cohort included 4 boys and 5 girls, aged 1-6 years (median, 3 years). Syndactyly of the second and third toes was present in 2 patients. Hypertrophy distribution was as follows: 1 case of single-ray involvement, 4 of double-ray, 1 of triple-ray, 1 of quadruple-ray, and 2 of quintuple-ray. Preoperatively, 7 cases exhibited limitations in both active and passive flexion and extension of the affected toes; in 2 cases, active movement was restricted while passive motion remained intact. All 9 children were unable to wear standard-sized footwear for the unaffected foot. Six presented with a limp, and 3 had difficulty walking. All 9 cases were moderate to severe progressive macrodactyly, and the growth rate of the affected foot was significantly faster than that of the healthy side. Six cases had undergone prior surgical interventions at other institutions, but disease progression continued postoperatively. All 9 patients underwent tibial nerve transection with epineurial suture and selective division of the common plantar digital nerve branches. At last follow-up, the foot growth rate was calculated (compared with that immediately after operation), and the changes of plantar pain sensation in the affected foot were detected before operation, immediately after operation, and at last follow-up, and the surgical efficacy was evaluated based on improvements in shoe fit and gait function. RESULTS: All 9 children were followed up 6-36 months, with an average of 18 months. All the incisions healed by first intention, and no infection or plantar ulceration occurred. At last follow-up, the growth rate of the affected foot was 0.10 (0.04, 0.14) cm/month, which was significantly slower than that of the healthy foot [0.14 (0.08, 0.18) cm/month] ( Z=3.951, P<0.001). Preoperatively, plantar pain sensation was absent in all cases; it was restored immediately after operation. At last follow-up, 6 patients had absent pain sensation, 2 had partial preservation (involving certain toes and central plantar regions), and 1 patient (with 3-year follow-up) exhibited regained sensation in multiple plantar areas. Gait improved in most cases, in which 8 children achieved normal ambulation, while 1 continued to limp due to leg-length discrepancy. Surgical efficacy were rated as excellent in 1 case, good in 7, and fair in 1. CONCLUSION Tibial nerve transection with epineurial suture combined with selective division of the common plantar digital nerve branches effectively reduces the growth rate of congenital macrodactyly in children, has minimal impact on plantar sensory function, and does not result in plantar ulcers or impaired ambulation.
Humans ; Male ; Female ; Child, Preschool ; Child ; Retrospective Studies ; Infant ; Tibial Nerve/surgery* ; Toes/surgery* ; Treatment Outcome ; Suture Techniques ; Fingers/surgery* ; Foot/innervation* ; Limb Deformities, Congenital

OBJECTIVETo investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.

METHODSIn the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.

RESULTSThe blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.

CONCLUSIONSIt is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.

Arteries ; anatomy & histology ; Cadaver ; Female ; Foot ; blood supply ; innervation ; Forefoot, Human ; injuries ; surgery ; Humans ; Male ; Muscle, Skeletal ; anatomy & histology ; Reconstructive Surgical Procedures ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Transplant Donor Site ; surgery

OBJECTIVETo investigate the therapeutic effect of primary reconstruction of skin avulsion injury with bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

METHODSFrom June 2005 to Aug. 2011, 4 cases with skin avulsion injury on both feet were treated. The bilateral anterolateral thigh flaps, including with anterolateral thigh cutaneous nerves, were transferred to cover the feet plantar. The thorax umbilicus flap or latissimus dorsi flap were used to cover the feet dorsum.

RESULTSAll the skin avulsion injury were reconstructed primarily. All the flaps survived completely with good cosmetic and functional results. The patients were followed up for 6 months to 2 years with good sensory recovery (two point discrimination: 14-18 mm).

CONCLUSIONThe skin avulsion injury on both feet can be primarily reconstructed by bilateral anterolateral thigh flaps combined with thorax umbilicus flap or latissimus dorsi flap.

Adolescent ; Follow-Up Studies ; Foot Injuries ; surgery ; Humans ; Lacerations ; surgery ; Myocutaneous Flap ; transplantation ; Reconstructive Surgical Procedures ; Skin ; injuries ; innervation ; Surgical Flaps ; innervation ; transplantation ; Thigh ; innervation

Adult ; Foot ; innervation ; surgery ; Humans ; Male ; Soft Tissue Injuries ; surgery ; Sural Nerve ; surgery ; Surgical Flaps ; innervation

OBJECTIVETo report the operative techniques and clinical results of modified superficial peroneal neurocutaneous propeller adipofascial-cutaneous flap for reconstruction of donor site defects at foot dorsum.

METHODSA propeller adipofascial flap with a skin pedicle (4-6 cm in width) based on the lateral superamalleolar perforating artery which vascularized the flap through the nutrient vessel chain of the superficial peroneal nerve was designed to repair defects after harvesting of foot pedicled dorsal flap. The defects at donor site of the leg was closed directly and split-thickness skin grafting was performed on the adipofascial surface of the flap primarily or secondarily.

RESULTSFrom May 2007 to Oct. 2011, 7 cases were treated. All flaps were transplanted successfully with satisfactory cosmetic and functional results. The flaps size ranged from 19 cm x 8 cm to 30 cm x 11 cm.

CONCLUSIONSThe flap has reliable blood supply with a relatively large vascularized area, long rotation are and minimum donor-site cosmetic morbidity. It' s a simple and safe procedure which is suitable for covering donor sites defects after harvesting foot pedicled dorsal flap.

Adult ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Peroneal Nerve ; transplantation ; Reconstructive Surgical Procedures ; methods ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Young Adult

OBJECTIVETo investigate the applied anatomy of the superficial peroneal artery perforator flap and report the clinical results of repairing the soft tissue defects with free perforator flaps.

METHODS15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software (Materiaise's interactive medical image control system, MIMICS). The origin, course and distribution of the superficial peroneal artery perforator in the anterolateral leg region were observed. Clinically 6 cases with hand defects and 6 cases with feet defects were treated with free superficial peroneal artery perforator flap transplantation. The defect size ranged from 3.0 cm x 4.5 cm to 5.0 cm x 11.0 cm.

RESULTSThe diameter of the superficial peroneal artery is (1.2 +/- 0.3) mm at its origin from the anterior tibial artery 5 cm below the fibula head. It is (5.6 +/- 1.8) cm in length. This artery is truly anastomosed with other perforators to form the chain of superficial peroneal nerve accessory artery. The superficial peroneal artery perforators [outer diameter (0.7 +/- 0.2) mm] with a vein are in the anterolateral leg region, supplying the skin in proximal-middle region. All the 12 cases were treated successfully. The clinical results were satisfactory after 3-12 months of following-up.

CONCLUSIONSThe superficial peroneal artery perforator flap has constantly, reliable blood supply, and good texture. It is a good option for repairing soft-tissue defect with free transfer.

Cadaver ; Fibula ; Foot ; Foot Injuries ; surgery ; Free Tissue Flaps ; blood supply ; innervation ; transplantation ; Hand Injuries ; surgery ; Humans ; Leg ; Perforator Flap ; blood supply ; innervation ; transplantation ; Peroneal Nerve ; Soft Tissue Injuries ; surgery ; Tibial Arteries

OBJECTIVETo report the operative techniques and clinical results of modified distally based superficial peroneal neurocutaneous flap for skin defect of the forefoot.

METHODSA reversed superficial peroneal neurocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot.

RESULTSThe modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm x 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput.

CONCLUSIONSThe modified flap has reliable blood supply with a relatively large size and long rotation arc. It is a simple and safe for covering medium to large defects in the forefoot.

Adolescent ; Adult ; Child ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Peroneal Nerve ; surgery ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; innervation ; Young Adult

OBJECTIVE: To explore the effect of length-width ratio (LWR)on partial necrosis in distally based sural neurofasciocutaneous flap. METHODS: Clinical data and operative pictures of 157 distally based sural neurofasciocutaneous flaps were reviewed and analysed. LWR of the flaps ranged from 2.83:1 to 7.14:1. Based on the LWR of the flaps, the flaps were divided into 5 groups: Group A(LWR≤3:1), Group B(3:1RESULTS: Of the 157 flaps, 125 survived uneventfully, 8 had distal epidermical necrosis, wound dehiscence occurred in 6 flaps, 18 flaps(11.5%) had distal partial necrosis. Partial necrosis occurred in none of the 6 flaps in Group A(0%), 4 of 26 flaps in Group B(12.5%), 2 of 56 flaps in Group C (3.6%), 8 of 50 flaps in Group D (16.0%), and 4 of 19 flaps in Group E(21.5%). There were no statistical differences in partial necrosis ratio between Group A and B, Group B and C, Group D and E(P>0.05). Partial necrosis ratio was higher in Group D than that in Group C(P<0.05). It was lower in the LWR<5:1 group (Group A+Group B+Group C) (6.8%, 6/88) than that in the LWR≥5:1 group (Group D+Group E) (17.4%, 12/69) (P<0.05). CONCLUSION When LWR of the flap is less than 5:1, probability of partial necrosis occurring in distally based sural neurofasciocutaneous flaps is low, and the flap can survive more reliably. The maximum LWR of the surrival flaps can reach 6-7:1.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Foot Injuries ; surgery ; Humans ; Leg Injuries ; surgery ; Male ; Middle Aged ; Necrosis ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; innervation ; pathology ; Young Adult

OBJECTIVETo study the clinical application of the neurovascular island flap of the calf supported by perforating branches of peroneal artery for the soft tissue defects of ankle and the foot.

METHODSThe flaps were used in 27 cases to repair the soft tissue defects of ankle and the lower leg from February 2004 to December 2007. Among them, 21 cases were male and 6 cases were female, ranging in age from 7 months to 64 years, with an average of 31.5 years. There were 7 cases with external malleolus, 5 cases with medial malleolus, 8 cases with dorsum of foot, 7 cases with achilles tendon. The range of soft tissue defects was from 2.5 cm x 3.5 cm to 10 cm x 24 cm and the range of flap was from 3 cm x 4 cm to 12 cm x 26.5 cm.

RESULTSSeven cases were lightly swelling and distension after operation from 3 to 7 days. After 7 days, the swelling subsidised gradually and all flaps survived. In the follow-up for 3-12 months with an average of 5 months, all flaps showed fine appearance without fat and clumsy. The function of donor site was very well.

CONCLUSIONThe neurovascular island flap of the calf supported by perforating branches of peroneal artery can provide reliable blood supply, long reversed distance and wide repairing limitation and the proximal end of flap can reach to popliteal fossa. It is a good method to repair the defects of the lower leg and the foot.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Foot ; blood supply ; innervation ; surgery ; Humans ; Infant ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; innervation ; Tibial Arteries ; surgery ; Young Adult

OBJECTIVETo evaluate therapeutic effects of traditional Chinese drug soaking,continual irrigation and focus elimination for foot osteomyelitis complicated with massive skin defect and denervation.

METHODSThere were 25 males and 28 females in the study. All the patients suffering from foot osteomyelitis complicated with massive skin defect and denervation were treated with comprehensive therapy including preoperative traditional Chinese drug soaking, skin release, focus elimination,continual irrigation, and two-stage suture if necessary. Among the patients, there were 42 cases of left foot and 11 cases of right one. Fifty-one patients complicated with skin defect and sinus tract,only 2 patients complicated with skin defect. There were 48 patients with denervation caused by spina bifida, 5 patients by other causes.

RESULTSThe follow-up duration was from 1 to 12 years,the mean time was about 5 years. Osteomyelitis recurred in 3 cases and skin defect reoccurred in original position in 9 cases.

CONCLUSIONThe methods of traditional Chinese drug soaking, continual irrigation and elimination of focus have good effects for foot osteomyelitis complicated with massive skin defect and denervation. To some degree,this therapy may avoid skin flap transplantation, bone graft and amputation. It deserves further studies and promotion.

Adolescent ; Adult ; Child ; Denervation ; Dermatologic Surgical Procedures ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Follow-Up Studies ; Foot ; Foot Diseases ; complications ; drug therapy ; surgery ; Humans ; Male ; Osteomyelitis ; complications ; drug therapy ; surgery ; Skin ; innervation ; Therapeutic Irrigation ; Young Adult