Flow-through anterolateral thigh perforator flap or medial sural artery perforator flap in repair of Gustilo Ⅲ C wound of foot / 中华显微外科杂志

Objective:To investigate the therapeutic effect of Flow-through anterolateral thigh perforator flap (ALTPF) or medial sural artery perforator flap (MSAPF) in repair of Gustilo III C wound of foot.Methods:From July 2015 to June 2021, 8 patients with Gustilo III C wound of foot were treated in the Department of Foot and Ankle Surgery of Wuxi No.9 People’s Hospital. The patients were 7 males and 1 female, aged 25-62 years old, and (45.88±12.96) years old in average. Flow-through ALTPF or Flow-through MSAPF were used to repair the defect according to the size of the wound and the length and diameter of the defect vascular. Among the patients, 6 were repaired with free Flow-through ALTPF, and 2 with free Flow-through MSAPF. The size of flap was 9 cm×5 cm-22 cm×8 cm with (115.00±46.16) cm 2 in average, and the vascular bridging was 6-12 cm in length, with (8.75±2.50) cm in average. All patients received outpatient follow-up. The appearance of the flap, blood supply of affected limb, healing of fracture and dislocation and the recovery of limb function were recorded. Maryland score was used to evaluate functional recovery. Results:The flaps survived uneventfully in all 8 patients, and the wounds in donor site healed primarily. All patients were followed-up for 6-22 months with (12.25±5.39 ) months in average. At the last follow-up, all the flaps had satisfactory contour in soft texture and blood supply without occlusion in the bridging vessels. The fractures and dislocation were healed, and the appearance and function of the foot recovered satisfactorily. The Maryland score showed excellent in 3 patients, good in 4 patients and fair in 1 patient.Conclusion:Flow-through ALTPF or MSAPF can selectively used to reconstruct the Gustilo III C wound of foot in one stage. The functional recovery of the affected limb was satisfactory and the clinical effect was good.

Comparative study of donor site complications between the medial sural artery perforator flap / 口腔疾病防治

Objective@#To demonstrate the advantages of performing medial sural artery perforator flap compared with forearm flap. @*Methods @# Between April 2010 and April 2011, 20 clinical cases were reconstructed using the medial sural artery perforator flap technique and compared with 20 forearm flap cases. Data on recent complications (in 2 weeks) and late complications (after 3 months) were collected. @*Results @#Of the 20 medial sural artery perforator flaps, Only 1 case needed a skin graft, while 19 cases were primarily closed, and 1 case occurred muscle necrosis. Only linear scar was found in the postoperative donor area, and the effect on appearance and function was slight. Of the 20 forearm flaps, all cases needed a skin graft. For the recent complications, 3 cases of effusion under the skin graft, 2 cases of partial necrosis and 2 cases of wound dehiscence were observed. For the late complications of the forearm, 16 cases of an abnormal sensation were observed in the forearm group and 5 cases of an abnormal sensation were observed in the medial sural artery perforator flap group, and these differences were statistically significant (P <0.05). Significant differences were not observed in the other subjective contrasts(P >0.05). Scarring and pigmentation were much more serious in the forearm cases than the medial sural artery cases (P <0.05), and significant differences in the functional objective examination results were not observed between the two groups (P >0.05). @*Conclusion @#The medial sural artery perforator flap represents a good alternative for oral and maxillofacial reconstructions of small- and medium-sized defects, and it presents advantages over the forearm flap since it has less donor-site morbidity.

Repair of small and medium-sized defects of dorsum pedis with medial sural artery perforator flap / 中华显微外科杂志

Objective To analyze the characteristics of medial sural artery perforator (MSAP) flap, and to ex-plore the practicality of repair of small and medium-sized defects of dorsum pedis with the flap. Methods Between March, 2012 to December, 2015, 12 patients with variable defects of 4.0 cm×3.0 cm to 4.0 cm×6.0 cm underwent MSAP flap reconstruction. There were 7 males and 5 females, aged from 19 to 49 years (mean, 32 years). The disease causes were crush injury in 6 cases, machine saw injury in 5 cases, and hot crush injury in 1 case. The size of flaps ranged from 4.0 cm × 5.0 cm to 5.0 cm×7.0 cm. All of the donor site was sutured directly. Postoperative follow up was done termly. Results All 12 flaps survived. The flap was similar to the surrounding normal skin, and all patients returned to ambulation. Eleven cases survived without a hitch, the other 1 of venous congestion was salvaged by venous thrombectomy and reanastomosis. Fol-lowed-up 5-24 months postoperative, the color of the flap was similar to the surrounding skin. All patients recovered walk-ing and shoe wearing function. The calf residual linear scar. Conclusion The MSAP flap provides thin soft tissue cover-age, enabling good functional recovery after defect reconstruction dorsum of forefoot, show the evident advantages.

The Usability of Medial Sural Artery Perforator Flap for Reconstruction of the Finger Defects

PURPOSE: Groin or abdominal flap, anterolateral thigh free flap, and radial forearm flap can typically be performed in large defects, however satisfactory results in functional recovery and aesthetic aspect have not been achieved using these methods. Medial sural artery perforator free flap is recommended as a complement to these disadvantages, therefore we report the functional and aesthetic results of this flap for reconstruction of large finger defects. METHODS: From January 2008 to December 2013, 10 patients with large soft tissue defect of the fingers were treated with medial sural artery perforator free flap. Six months after the final surgery, metacarpophalangeal joint and proximal interphalangeal joint range of motion was measured, and the circumference of the reconstructed finger was compared with that of the contralateral side. In addition, for assessment of the aesthetic satisfaction, the patients and three physicians compared the color of the reconstructed finger with that of adjacent skin on a five-point scale. RESULTS: The flaps survived without complications in all ten cases. Average flexion was 77 degrees in the metacarpophalangeal joint and 84 degrees in the proximal interphalangeal joints. The average circumference of the reconstructed finger was measured as 12 percent larger than contralateral. The patien's subjective satisfaction (4.1) and physicians' objective satisfaction (4.2) regarding aesthetic aspect were very good. CONCLUSION: Medial sural artery perforator free flap is a very thin, stable, fasciocutaneous flap which has a tendon gliding effect and produces aesthetically good results. Therefore we consider medial sural artery perforator free flap as the flap which can solve the drawbacks of other techniques associated with large finger defect reconstruction.

Reconstruction of the skin and soft defects of hand and foot by free medial sural artery perforator flap / 中华显微外科杂志

ObjectiveTo evaluate the curative effect of reconstruction of the hand and foot defects with bones and tendons exposure using free medial sural artery perforator flap(MSAP). MethodsRadiographs of 2 cadavers injected with a modified lead oxide-gelatin mixture were digitally analyzed. Between April 2007 and December 2010, thirty-four patients with soft tissue defects in the distal limb were treated with the free MSAP flap transplantation. The sizes of the defect ranged 6 cm × 4 cm-13 cm × 8 cm, and the flaps ranged 7 cm× 5 cm-14 cm × 9 cm. These clinical cases included 25 hands and 9 feet, all of them with bones and tendons exposure.In these defects,twenty-two were clean,twelve got infections.In our cases, twenty-three flaps were nourished with single perforator vessel and else 11 with two;perforator vessel fifteen flaps were dissected one superficial vein to anastomose with that of the recipient sites in addition to accompanying vein anastomosis;The sensation of 9 flaps recovered the hands were reconstructed with cutaneous nerve anastomosis. ResultsA partition of the calf skin blood vessels,and three-dimensional reconstruction image of the sural artery were obtained.All flaps survived,five of them appeared partially violet and bubbles. Followed up 6-21 months, the cosmetic results were satisfactory and without apparent bulkiness.The flap colors were similar to recipient sites. The flap senses reconstructed with neural anastomosis recover to S2-S3. ConclusionThe new flap is very suitable to repair the soft tissue defect in the distal limbs,because the fairly constant perforator vessel,the reliable blood supply and the cosmetic shape of the MSAP flap are all advantages of it in addition to no damage to low leg chief artery and gastrocnemius.

The anatomical basis of the medial sural artery perforator flaps / Base anatómica de los colgajos perforantes de la arteria sural medial

OBJECTIVES: To study the perforators of the medial sural artery and the possible size of their flap. METHODS: The external iliac arteries of ten adult preserved cadavers (males and females) were injected with a mixture of red latex and lead oxide. The skin was reflected and the medial sural artery and its perforators were identified. The diameters and origins of perforators were measured from the central popliteal crease. RESULTS: The medial sural artery originated from the popliteal artery in 70% and had its external diameter at a mean of 3 ± 0.02 mm and was accompanied by two venae comitantes. The number of its perforators was at a mean of two perforators. Length of the pedicle of the medial sural artery perforator flap was at a mean of 18 ± 0.03 cm. The largest of the perforator had an average external diameter of 0.9 mm. The perforators ramified the skin with branches of the artery accompanying the posterior cutaneous nerve and the perforating branches of the peroneal and the posterior tibial arteries. The possible size of the medial sural perforators flap was at an average 8.2 cm × 13.3 cm. CONCLUSION: The medial sural artery perforator flap has at least one or two perforators with an average size of 8.2 cm × 13.3 cm. Elevation of the flap will not affect the vascularity of the gastrocnemius muscle.

OBJETIVOS: Estudiar los perforantes de la arteria sural medial y el posible tamaño de su colgajo. MÉTODOS: A las arterias ilíacas externas de diez cadáveres adultos preservados (varones y hembras) se les inyectó una mezcla de látex rojo y óxido de plomo. La piel fue reflejada y la arteria sural medial y sus perforantes fueron identificados. Los diámetros y orígenes de los perforantes fueron medidos desde el pliegue poplíteo central. RESULTADOS: La arteria sural medial se originaba partiendo de la arteria poplítea en 70%. Su diámetro externo alcanzaba un valor medio de 3 ± 0.02 mm y estaba acompañada de dos venas comitantes. El número de sus perforantes fue de dos como promedio. La longitud del pedículo de la arteria sural medial tuvo un valor promedio de 18 ± 0.03 cm. El perforante mayor tuvo un diámetro externo promedio de 0.9 mm. Los perforantes ramificaron la piel con ramas de la arteria que acompaña el nervio cutáneo posterior, y las ramas perforantes de las arterias tibiales posteriores y fibulares o peroneas. El tamaño posible del colgajo perforante sural medial tuvo un valor promedio de 8.2 cm × 13.3 cm. CONCLUSIÓN: El colgajo perforante de la arteria sural medial posee al menos uno o dos perforantes con un tamaño promedio de 8.2 cm × 13.3 cm. La elevación del colgajo no afecta la vascularidad del músculo gastrocnemio.

Anatomical study and clinical application of the medial sural artery perforator flap / 中华显微外科杂志

@#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.

Medial sural artery perforator pedicled flap for the coverage of soft tissue defects around the knee and upper ORe third of lower leg / 中华显微外科杂志

Objective To summarize clinical application of the medial sural artery perforator pedicled flap for the coverage of soft tissue defects around the knee and upper one third of lower leg.Methods From May 2003 tO January 2007,16 patients(11 men,5 women)with soft tissue defects around the knee and upper one third of lower leg underwent reconstruction with the medial sural artery perforator pedicled flap.Of them,4 eases recipient site were located on the prepatellar region,2 cases were located on the anterolateral pateflar,1 case was located on the anteromedial patellar,and 9 cases upper one third oflowerleg.They ranged in age from 23 to 52 years(mean,36 years).The donor leg was ipsilateral in all cages. Results One ca8e sustained superficial infection postoperative and the gradual wound healed by daily wound dressings.All the flaps had survived completely without major complication with satisfactory clinical results. Follow-up period ranged from 3.0 months to 3.5 years(mean, 1.7 years)postoperatively.There was no remarkable donor site morbidity.All cases had good appearance and function in recipient site.There was no remarkable donor site morbidity. Conclusion The medial sural artery perforator flap is nourished by the musculocutaneous perforater of the medial sural artery.The flaps seem to has highly vascularize,a constant vascular anatomy and a long vascular pedicle.The flap is thin and suitable for the coverage of soft tissue defects around the knee and upper one third of lower leg.

Soft Tissue Coverage Using a Combined Gastrocnemius-medial Sural Artery Perforator Flap

Medial gastrocnemius flap has been known as a useful option for soft tissue reconstruction of the knee and upper 1/3 of lower extremity, but it has a limitation to cover the lateral defect of the knee joint. We performed the combined gastrocnemius-medial sural artery perforator flap for coverage of the anterolateral defects of the knee joint, which is compound flap using a medial gastrocnemius flap and a medial sural artery perforator flap. This flap is a useful method for reconstruction of anterolateral knee defects, providing a easy dissection without the microsurgery and intramuscular dissection of the perforators.

Novel Method of the Upper One Third of Lower Leg and Knee Reconstruction

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.

Free medial sural artery perforator flap for the tissue defect in the upper or lower limbs / 中华显微外科杂志

Objective To report 11 cases with the tissue defects of their upper or lower limbs repaired with the anastomsed medial sural artery perforator flaps.Methods The free medial sural artery perforator flaps,with length of 8 cm to 15 cm and width of 6 cm to 14 cm were used for tissue defect reconstruction of the distal upper or lower limbs in 11 cases,including 6 females and 5 males.The flap was harvested from the ho- mo-lateral calf,confined between the posterior-medial edge of the tibia and the middle line of the calf and a- bove the distal half part of the medial sural muscle,with a same axis of this muscle.Results Ten cases survived very well,which was relatively thin,and the donor site can be acceptable.One case resulted in a complete flap necrotized and covered with a split skin graft.No obvious motor function defect was observed of the donor leg.Conclusion The anastomsed medial sural artery perforator flap is alternative donor flap for the upper or lower limb tissue defect repair,especially for the defect in the hand or foot.