Clinical application of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect / 中华显微外科杂志

Objective To investigate the clinical effect of lateral supramalleolar perforator flap with the rotation point down on the repair of forefoot soft tissue defect.Methods From January,2016 to June,2017,23 cases (15 males and 8 females) of forefoot soft tissue defect were repaired by lateral supramalleolar perforator flap with the rotation point down.The age ranged from 8 to 67 (mean,42.9) years.The soft tissue defects were located far from the tarsometatarsal joint of the foot and the areas were 4.0 cm×4.0 cm-8.0 cm×12.0 cm.The areas of flap stitched directly or take blade thick skin repair on the thigh.All cases were followed-up by telephone or Internet,outpatient visit and home visit.Results Twenty-one cases survived successfully.Small area necrosis occurred at the distal end of the flap in 1 case,and healed after changing treatment.In the other cases,tension blister appeared at the distal end of the flap.After cut off some surgical stitches,the flap survived.All cases were followed-up from 6 to 12 months.The shape of flaps were not bloated and had good textures.The walking of affected limbs had no significant effect,and the functional recovery was satisfactory.Conclusion The lateral supramalleolar perforator flap is easy to cut and the perforator of flap is constant,which is a appropriate flap to repair the soft tissue defect of the forefoot.

Repair of lateral calcaneal wound with the lateral supramalleolar flap pedicled with the end perforator of peroneal artery / 中华显微外科杂志

To explore the method and effect of repairing the soft tissue defect of the lateral heel with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery. Methods From May, 2015 to February, 2018, 16 cases of lateral calcaneal soft tissue defect were repaired with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery.All wounds were treated with one-stage dilata-tion and VSD to control infection. In cases of chronic calcaneal bone infection, the bone defect formed after extensive resection of infected bone was temporarily filled with antibiotic bone cement. The area of soft tissue defect on the lat-eral heel was 3.0 cm×2.0 cm-8.0 cm×5.0 cm, and the area of flaps was 3.5 cm×2.5 cm-8.5 cm×5.5 cm. The small donor area of the flap was sutured directly, and the larger area was repaired by skin grafting. Patients with chronic calcaneal bone infection underwent bone cement removal and autogenous bone transplantation after inducing mem-brane formation 6 to 8 weeks after flap transplantation. All cases were followed-up, including 7 cases outpatient fol-low-up and 9 telephone follow-up. Results All the 16 flaps survived smoothly. The donor and recipient areas of the flaps healed primarily. All cases were followed-up for 3 to 13 months. The flaps had good shape, no swelling, similar color to heel skin and no pigmentation.Ankle flexion and extension were not restricted.Four cases with chron-ic osteomyelitis of calcaneus healed well after second-stage bone grafting, with an average healing time of 8.5 months. Conclusion The retrograde lateral supramalleolar flap with the end perforator of peroneal artery is an ideal method for repairing the soft tissue defect on the lateral heel with simple operation and reliable blood supply.