Dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of dominant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs, ankles and feet.</p><p><b>METHODS</b>From July 2003 to Feb. 2011, 39 cases, with defects caused by high energy at lower legs, ankles and feet, were retrospectively studied. The defects were covered primarily by one or two perforator neurocutaneous flaps (free or pedicled) which were based on a dominant perforator arising from the posterior tibial or peroneal artery (including the lateral supramalleolar perforating artery which is also from the peroneal vessel) respectively through sural, saphenous and superficial peroneal neurocutaneous vascular axis.</p><p><b>RESULTS</b>39 cases with 44 defects were treated by 32 sural neurocutaneous flaps based on the peroneal perforator (5 free and 27 pedicled), 6 saphenous neurocutaneous flaps on the posterior tibial perforator (1 free and 5 pedicled) and 6 superficial peroneal ones on the lateral supramalleolar perforating artery. The largest flap size was 22 cm x 10 cm. All flaps were survived successfully without necrosis. The average in-hospital time was 23 days ( ranged from 12-36 days).</p><p><b>CONCLUSIONS</b>The three kinds of dominant perforator neurocutaneous flaps have reliable blood supply with a relatively large size. They can be chosen and designed individually for all kinds of defects over the lower leg, ankle and foot. There are many advantages in a primary procedure, such as easier dissection, better vessel status in or around recipient areas, less secondary necrosis and lower risk of chronic infection. Moreover, the reduction of granulation and scar tissues benefit functional rehabilitation.</p>

Study of distribution of dominant perforators arising from peroneal artery with color Doppler flow imaging and its clinical significance for sural neurocutaneous flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap.</p><p><b>METHODS</b>The dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques.</p><p><b>RESULTS</b>The average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%.</p><p><b>CONCLUSIONS</b>According to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.</p>