ABSTRACT
Objective@#To investigate the therapeutic effect of propeller flap with low peroneal artery perforator for defects at ankle and heel.@*Methods@#From January 2009 to March 2016, 28 cases with skin defects at ankle and heel were treated with propeller flap pedicled by low peroneal artery perforator, including 15 cases of car accidents, 8 cases of pressure injury, 3 cases of wring injury and 2 cases of electricity shock injury. Defects size ranged from 3 cm×3 cm to 4 cm×6 cm. The fibular was divided into 9 segments from head to external ankle. Doppler ultrasound was used to locate the low peroneal artery perforator from the lower 6-9 segments. The flap pivot point was at perforator point at skin surface, with the peroneal artery as flap axis. The length of big blade was the distance from rotate point to distal end of defects. The flap width was half of the length. The ratio of big blade length to width should not exceed 2∶1. The flaps size was from 3 cm×5 cm to 4 cm×10 cm, based on the defect size. The defects at donor site could be closed with small blade directly.@*Results@#Partial necrosis happened in 1 case due to veneous crisis, which healed after dressing. All the other 27 flaps survived completely. During the follow-up period, the flaps had good match in color and thickness. No secondary operation was needed.@*Conclusions@#The optimization of propeller flap with low peroneal artery perforator is an idealmethod for defects at ankle and heel, which can avoid the necrosis at distal end of flap.
ABSTRACT
Objective@#To report operative techniques and clinical results of free sural cutaneoadipofascial flap containing the neurovascular axis based on a dominant peroneal perforating artery (DPPA, with a caliber≥0.8 mm) and its concomitant veins for reconstruction of dorsal forefoot soft tissue defects.@*Methods@#The flap was applied in 32 cases with middle to large soft tissue defects in the dorsal forefoot from Aug. 2009 to Dec. 2014. DPPAs arising from the posterolateral intermuscular septum was located and assessed preoperatively with color Doppler flow image and computed tomography angiography. According to the location, size, and shape of the defects, one of these DPPAs was chosen for flap planning. The flap was harvested from the posterolateral aspect of the leg. The neighboring neurovascular axis (one or more of that of the sural nerve, the medial cutaneous nerve, the lateral cutaneous nerve of calf and the sural communicating nerve) was included to ensure vascular supply. According to skin laxity of the donor site, the width of the full harvesting part which should be able to cover the region of the recipient site where pressure and friction force were prominent while wearing shores was decided; the rest was harvested as an adipofascial flap (without skin) to get enough size. After transfer to recipient site, the flap was revascularized by anastomosing the perforating artery and its venae comitantes with appropriate recipient vessels, and reinnervated (antegrade or retrograded methods). Skin grafting was performed on the adipofascial surface of the flap primarily or secondarily. The defects in donor site of the leg was closed directly.@*Results@#All flaps (ranged from 7.5 cm×5.0 cm to 23.0 cm×13.0 cm) were transplanted successfully, and no vascular or donor site problems occurred. All primary skin grafts (19 cases) was partially lost, but only 2 of them need a second grafting. Adipose necrosis occurred in 4 of 13 cases receiving secondary grafting but only needed wound care before surgery. Following up for 11-26 months showed both satisfactory functional and cosmetic results without problems of shoe wearing. Flap sensibility restored at least to the degree of S3.@*Conclusions@#The cutaneoadipofascial flap combines the advantages of perforator, neurocutaneous axis, free and adipofascial flaps leaving only suture scar in the donor leg, and is a satisfactory method for free-style and acute coverage of dorsal forefoot defects.