ABSTRACT
Objective To reports to anatomy and clinical application of the medialis pedis perforator flap. Methods The origin, course, distribution and out diameter of medial plantar perforators, which were located at the septums between the abductor hallucis muscle and the flexor digitorum brevis, and between the abductor hallucis muscle and the skeleton, were observed on 10 sides adult feet specimens perfused with red latex. 11 free medialis pedis perforator flaps were transferred for soft-tissue defect in hand. The areas of tissue defect ranged from 2 cm x 2 cm - 9 cmx 4 cm. Results The medial plantar artery sends 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and the flexor digitomm bre-vis, and 2 perforators with regular anatomy through the septum between the abductor hallucis muscle and nav-icluar bone and the medial cuneiform bone. These perforators supply the medial plantar flap and medialis pedis flap respectively. All of the 11 cases of free medialis pedis perforator flap survived uneventfully. The flap areas ranged from 2 cm × 3 cm - 11 cm× 5 cm. The appearance and functional results were satisfactory with following up for 6 to 24 months. Conclusion The free medialis pedis perforator flap is a good method in repairing soft-tissue defect in hand.
ABSTRACT
@#Objective To report the anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap. Methods Latex injection studies were performed on 24 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel artery and its perforators in the distal leg were documented. 16 vascularized fibul osteoseptocutaneous flaps were performed for reconstruction of composite soft-tissue defect of limbs. The flap areas ranged from 6 cm×4 cm to 16 cm× 8 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. 40.6% of them were muscularcutanous perforators, and the other were septacutanous perforators. The perforating vessels were all located within 3.1 cm from the postlateral fibula. The average diameter was 1.1 mm at the deep fascial level, and the interval of them was 4-8 cm. There were two constant perforators which located about 15-25 cm and 4-7 cm from the lateral maleolar respectively. All of the 16 clinical cases survived uneventfully and the time to union of the graft-host junction site were 3 to 5 months. The appearance of flaps and the function of the limbs were satisfied during 10 to 36 months following up. Conclusion It is the anatomic basis that there are pedorating vessels of the peroneal constantly. The vnscularized compound fibula perforating osteoseptocutaneous flap has the advantage of flexible design. It is the safe and suitable choice in the cases when compound bone and soft tissue defects of the limbs are required for reconstruction.
ABSTRACT
@#Objective To report the anatomical study and clinical application of the medial sural artery pertorator flaps. Methods The anatomical study involved 12 fresh adult cadaver lower legs, the arteries of which were perfused with suspensions of lead oxide and gelatine. The bifurcation, location, length, diameter and blood territories of the medial sural artery and its perforating vessels were recorded by dissection, angiography and photography. The integument of the leg was dissected and ridiographed. The tendency of the vessels was analyzed, the surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. With the aid of anatomic study, a series of five clinical cases was reported, including five free medial sural flaps for ipsilateral hand reconstruction. Results There was at least one perforating vessel in the medial sural areas of the specimen. A mean of 2.1 perforators was noted over the medial gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease, 1 to 5 cm from the posterior medial line. Their diameter was (1.03±0.22)mm at the deep fascial level. The average vascular territory on the sural area was (107.5±23.9)cm2, and the average supplying area of single perforator was (58.3±17.0)cm2. All the transferred free flaps taken in the 5 clinical cases survived uneventfully. All the patients were followed-up from 6 months to 12 months. The appearance of flaps and the function of the limbs were satisfied. Conclusion The standard method for the study of perforator flap is the lead oxide-gelatin technique. It is the anatomic basis that there are perforating musculocutaneous vessels on the medial gastrocnemius muscles constantly. The free medial sural perforator flap has the advantage of good appearance. It is the safe and suitable choice in the cases when a medium or small-sized flap is required for resurfacing hand injuries.