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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.
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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.
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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.
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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.
Subject(s)
Humans , Arteries , Complement System Proteins , Fingers , Forearm , Free Tissue Flaps , Groin , Joints , Metacarpophalangeal Joint , Perforator Flap , Range of Motion, Articular , Skin , Tendons , ThighABSTRACT
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.
ABSTRACT
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.