Repair of soft tissue defect of ankle and foot with propeller flap pedicled with perforating branch of peroneal artery / 中华显微外科杂志

Objective:To investigate the clinical effect of propeller flap pedicled with perforating branch of peroneal artery in repairing soft tissue defects of ankle and foot.Methods:From August 2018 to August 2021, 15 cases of soft tissue defect of ankle and foot were repaired with propeller flap pedicled with perforating branch of peroneal artery in the Department of Hand and Microsurgery, Baoji Third Hospital. Among them, there were 7 cases with soft tissue defect in heel, 6 cases in lateral ankle and 2 cases in front of ankle. The size of defects was 3.0 cm×3.5 cm-5.5 cm×4.0 cm, and the size of flaps was 5.0 cm×4.5 cm-12.0 cm×6.0 cm. In 7 cases, the donor sites were closed directly with the aid of small paddle. The donor sites in other cases were covered with medium thickness skin graft after the wounds were narrowed by pull-up suture. The clinical efficacy was evaluated by follow-up at outpatient clinic and via telephone or WeChat interviews. Functional recovery was evaluated according to the American Orthopedic Foot Ankle Society (AOFAS) -Marylad.Results:Among the 15 flaps, 2 had distal necrosis and healed after dressing change; One flap was swelling and had venous osculation, but relived 2 weeks later. The rest of the 12 flaps survived smoothly. At the final follow-up: the shape and texture of the flap were good, and the protective feeling was restored; The ankle also recovered the normal flexion, extension and weight-bearing. According to the AOFAS-Marylad, function recovery were excellent in 9 cases, good in 4 cases, and fair in 2 cases.Conclusion:It is simple, safe and reliable to repair the soft tissue defect of foot and ankle with propeller flap pedicled with perforating branch of peroneal artery. It does not sacrifice the main blood vessels of limb, and the blood supply of the flap is reliable. It is an ideal operation for repairing the soft tissue defects of ankle and foot.

Analysis of the causes and the countermeasures for the serious complications after perforating pedicle flap of lower leg / 中华显微外科杂志

Objective To analysis causes of the serious complications after the operation of the lower leg perforator pedicle screw flap, and to explore the corresponding countermeasures. Methods From June, 2012 to Au-gust, 2016, 60 cases of soft tissue defect of ankle and foot were repaired with propeller flaps pedicled with perforator of lower legs. with the area were soft tissue defect ranged from 3.0 cm ×2.0 cm to 19.0 cm ×9.0 cm, and all with bone exposure. Two cases of traumatic tissue defect, 7 cases were chronic osteomyelitis of the distal tibia, 13 cases were in-cision infection and necrosis after the operation of ankle joint fracture and Pilon fracture, 10 cases were simple inci-sion necrosis after calcaneal fracture, 18 cases were calcaneal osteomyelitis, 1 case were soft tissue defect after the ankle tumor operation, 6 cases were soft tissue necrosis after the Achilles tendon rupture, and 3 cases were soft tissue defect of the dorsum with infection. The posterior tibial artery perforator pedicled propeller flap was used in 18 cases. The pedicle of the vascular pedicle was 6.0-18.0 cm from the medial malleolus, the flap rotation was 135 °-180° . There were 42 cases of the perforator pedicle propeller flap of the peroneal artery, 5.0-18.0 cm from the pedicle of the vascular pedicle and 120°-180° rotation in the flap. The area of the flap was 9.0 cm ×3.0 cm-34.0 cm ×18.0 cm. There were 32 cases of direct suture in the donor site and 28 cases of free skin grafting. Results The color, swelling, elasticity, capillary reaction and healing of donor site were observed after operation. There was no flap ischemia occurred in 60 patients. Fourteen cases had venous reflux obstruction, all of which had swelling above II degree, 8 cases had swelling above III degree with obvious purple blood stasis, resulting in partial flap necrosis in 4 cases, all necrosis in 1 case, including 4 cases of free skin grafting, 1 case of flap transplantation and repair. There were 3 cases of necrosis after skin grafting in the flap area, all of which were partial necrosis. There was case of necrosis of the wound surface after di-rect suture of the donor site and 1 case of skin disintegration after disassembly, and all wounds healed after the replace-ment of the wound and the external use of the dried blood powder. All the 60 patients were followed-up for 12 to 30 (mean, 24.5)months. The flaps survived and the donor site scars healed well. The range of motion of the ankle was from-10°to 10°(mean, 5.6 °) and the flexion of the plantar was from 20 °to 50 °(mean, 37.8 °). Fourteen patients with venous reflux disorder were followed up for 15 to 28(mean, 22.3)months. The flap and skin graft survived well. Ankle dorsiflexion ranged from-10° to 10 °(mean, 2.4 °) and plantar flexion from 20° to 45 °(mean, 35.6 °). There was no obvious limp in walking. Conclusion Although the overall effect of the lower leg perforator pedicle propeller flap to repair the soft tissue defect of the foot and ankle is satisfactory, there are still various serious complications, which are mainly due to ia-trogenic. Doctors should strictly follow the basic principles of skin flap surgery from preoperative to postoperative, and during operation and postoperative management, so as to reduce the incidence of complications.

Application of the medial plantar flap on repairing the medial ankle and foot soft tissue defects / 中国综合临床

Objective To investigate the application and clinical significance of the medial plantar flap on repairing the medial ankle and foot soft tissue defects. Methods A total of 13 patients with the medial ankle and foot soft tissue defects were repaired by the local transferred medial plantar flap alone or in combination with sural neurovascular flap transplantation in the Yuebei People's Hospital Affiliated to the Medical College of the Shantou University from Jun. 2006 to Dec. 2012. Results All patients were followed-up of 4-21 weeks,and the average follow-up periods were 6. 3 weeks. All of the skin and soft tissue defects of the medial ankle and foot were repaired,and there were 2 cases of partial necrosis of flap were repaired after tow times skin grafting operation,and all cases without complications of wound infection or iatrogenic nerve injury. Conclusion The medial plantar flap on treating ipsilateral medial malleolus and foot skin and soft tissue defects is useful and effective with less complications,satisfactory effects,intact the ankle flexor and extensor device,allowing early functional exercise,good functional recovery.

The modified peroneal artery perforator-based propeller flap for the reconstruction of distal lower extremity defect / 中华显微外科杂志

Objective To explore the feasibility and clinical effect of modified peroneal artery perforatorbased propeller flap which excludes small saphenous vein and sural nerve for coverage of the soft tissue defects of the ankle and foot.Methods From January,2009 to August,2013,20 patients with soft tissue defects of the foot or ankle underwent the procedures of reconstruction.After the proper perforators being identified with doppler sonography,the propeller flap was designed,which selected the location where terminal perforator vessels perforate deep fascia as the pivot point,the line from this point to the point where the second perforator near the wound around the line from the midpopliteal point to the midpoint of the achilles tendon and lateral malleolus perforated the deep facia as the axis.The flap was raised above the level of the deep fascia.The small extrinsic vessels around the sural nerve and small saphenous vein were contained in the flap,while the small saphenous vein and sural nerve were kept in the original position.The donor site was closed directly.The skin flaps measured from 7 cm × 4 cm to 21 cm × 7 cm.Results All 20 flaps survived completely without complications.During 10-28 months' followed-up (average 13 months),all flaps showed good texture matches and contour.All patients recovered walking and shoe wearing function.No one showed sensory disturbances at the lateral foot.Conclusion The modified peroneal artery perforator-based propeller flap excluding small saphenous vein and sural nerve still has stable blood supply,which is an idea way for covering skin and soft tissue defects in foot and ankle.

Coverage the soft tissue defect in the foot and ankle with peroneal artery perforator-based sural neurocutaneous island flap / 中国基层医药

Objective To study the methods and therapeutic effect of coverage the soft tissue defect in the foot and ankle with neurocutaneous sural artery island flap.Methods 30 patients had been reconstructed foot and ankle soft-tissue defects with neurocutaneous sural artery island flap,the area of soft tissue defect from 2.0 cm × 3.5 cm～ 8.0 cm× 16.5 cm,the flaps were designed with the size measuring 2.5 cm × 4.0 cm to 8.5 cm × 18cm.Results 26 flaps survived completely and 4 with partial or margin necrosis,the wound infection occurred in 6 patients and were treated with dressing,shin graft and antibiotic drug.Conclusions Sural neurocutaneous island flaps are easy to separate.Major arteries are not injured.It is the ideal flap to repair the soft tissue defect around ankle and foot,the texture,color and contour of the flap is similar to recipient area.

Rehabilitation of Common Ankle and Foot Sports Injuries / 한양의대학술지

Ankle and foot injuries are endemic to all sports that involve running, jumping, cutting, or kicking. Ankle injuries, especially ligament sprains are the most common injuries seen at all levels of athletic participation. Although many of ankle and foot injuries are well recovered after short-term conservative managements, there are not uncommon patients with chronic pain and dysfunction after acute injury because of improper diagnosis and rehabilitation. In this chapter, a brief review of functional anatomy, biomechanics, and clinical aspects are presented, followed by a special discussion of rehabilitation of various injuries that may involve the ankle and foot.

Rehabilitation of Common Ankle and Foot Sports Injuries / 한양의대학술지

Ankle and foot injuries are endemic to all sports that involve running, jumping, cutting, or kicking. Ankle injuries, especially ligament sprains are the most common injuries seen at all levels of athletic participation. Although many of ankle and foot injuries are well recovered after short-term conservative managements, there are not uncommon patients with chronic pain and dysfunction after acute injury because of improper diagnosis and rehabilitation. In this chapter, a brief review of functional anatomy, biomechanics, and clinical aspects are presented, followed by a special discussion of rehabilitation of various injuries that may involve the ankle and foot.

One-stage Reverse Lateral Supramalleolar Adipofascial flap for Soft Tissue Reconstruction of the Foot and Ankle Joint

PURPOSE: To report the clinical results and efficacies of one stage reverse lateral supramalleolar adipofascial flap for soft tissue reconstruction of the foot and ankle joint. MATERIAL AND METHODS: We performed 5 cases of one stage reverse lateral supramalleolar adipofascial flap from Jan 2005 to Sept 2005. All patients were males and mean age was 50(36~59) years old. The causes of soft tissue defects were 1 diabetic foot, 2 crushing injuries of the foot, 1 open fracture of the calcaneus, and 1 chronic osteomyelitis of the medial cuneiform bone. Average size of the flap was 3.6(3~4)x4.6(4~6) cm. All flaps were harvested as adipofascial flap and were performed with the split-thickness skin grafts (STSG) above the flaps simultaneously. RESULTS: All flap survived completely and good taking of STSG on the flap was achieved in all cases. There were no venous congestion and marginal necrosis of the flap. In diabetic foot case, wound was healed at 4 weeks after surgery due to wound infection. There was no contracture on the grafted sites. Ankle and toe motion were not restricted at last follow up. All patients did not have difficulty in wearing shoes. CONCLUSION: The reverse lateral supramalleolar adipofascial flap and STSG offers a valuable option for repair of exposure of the tendon and bone around the ankle and foot. Also one stage procedure with STSG can give more advantages than second stage with FTSG, such as good and fast take-up, early ambulation and physical therapy, and good functional result.

MRI Features of Foot Fatigue Fracture Without X-ray Film Abnormality / 实用放射学杂志

Objective To study the MRI features of the fatigue fracture of ankle.Methods 15 patients including 11 man and 4 women were studied.The age of the patients ranged from 15～45 years,with average of 22 years.All cases had no traumatic history of ankle joint and a negative result of plain radiographs,and its clinical symptoms was pain in the local site of feet.Siemens 1.5T MRI with SE and FSE were used to investigate the ankle,T 1WI(TR/TE=700/20)and T 2WI(TR/TE=4700/100) and T 2WI fat surpassion.Results All cases demonstrated abnormal MRI signals in both T 1 and T 2 weighted image:6 involving the talus,7 involving calcaneus,1 case located the navicular bone and 1 case involving both talus and calcaneus.15 cases with 16 were abnormalities of bone marrow,which 10 demonstrated hypointensity on T 1WI and hyperintensity on T 2WI,6 cases with hypointensity on T 1WI and complex signal intensity on T 2WI.Conclusion MR features of fatigue fracture of ankle joint without abnormality in X-ray films include trabecular fracture under cortical bone and edema in the trabecular bone which demonstrate irregular abnormal signal in MRI.