Flap of distal cutaneous perforator of medial plantar artery in reconstrution of destructive defect in the base plane of proximal phalange of great toe / 中华显微外科杂志

Objective:To investigate the clinical effect of perforator flap of distal cutaneous perforator of medial plantar artery in recon struction of destructive defect in the base plane of proximal phalange of great toe.Methods:Twenty-six patients were treated in the Department of Foot and Ankle Surgery of Xuzhou Renci Hospital from September 2017 to December 2021. The patients were 24 males and 2 females, aged 26 to 60 years old. There were 12 defects in left foot and 14 in right foot. All the defects were the residual wounds at the first metatarsophalangeal joint with the defect at 2.0 cm × 3.0 cm - 4.0 cm × 5.0 cm in size. The flaps pedicled with distal cutaneous perforator of the medial plantar artery were used to repair the defects, with a size at 3.2 cm× 4.2 cm in average. Skin grafts were employed to repair the donor sites. Postoperative patient management including lifting the affected limbs and keeping warm, anti-infection, detumescence, anti-coagulation and pain relief.Results:All patients were entered in postoperative follow-up at outpatient clinic for 1-3 years. Twenty-two flaps survived after surgery, except 4 that had dark purple edge indicating venous congestion. Blood supply of the flap was regained after the tension of the flap was relieved by interval suture removal. Appearance of flaps was good, without obvious swelling nor pigmentation, good in elasticity, in hard texture and with good wear resistance. Patients showed no limp of the affected limbs, and without restriction in wearing shoes or walking. The function of feet was evaluated according to the American Orthopedic Foot and Ankle Societ (AOFAS) I50, with 24 patients in excellent and 2 in good.Conclusion:The anatomy of the flap pedicled with distal cutaneous perforator of the medial plantar artery is relatively constant. It provides a blood supply and does not affect the trunk of major artery. The flap has a thick skin cuticle hence it is wear-resistant. This flap provides a choice to the repair of a defect at proximal segment of great toe.

Efficacy of medial plantar flap combined with medial foot flap for repairing weight-bearing area defects of the foot / 中华创伤杂志

Objective:To investigate the clinical effect of combining medial plantar flap with medial foot flap for repairing weight-bearing area defects of the foot.Methods:A retrospective case series study was used to analyze the clinical data of 12 patients with weight-bearing area defects of the foot, who were admitted to the Affiliated Hospital of Zunyi Medical University from March 2020 to March 2022. There were 9 males and 3 females, with the age of 27-62 years [(39.3±8.7)years]. There were 4 patients with palm defects and 8 with heel defects. The defect area ranged from 10 cm×8 cm to 13 cm×12 cm. The cutting area of skin flap ranged from 11 cm×8 cm to 14 cm×13 cm. A total of 5 patients were treated with free flaps (4 patients with palm and 1 with heel defects) and 7 with pedicled flaps (all with heel defects). The flap donor areas were repaired with skin grafting. The flap survival was observed after surgery. At the last follow-up, the appearance, texture, and two point discrimination of the flap were recorded; the foot function was evaluated by Maryland foot function score; the sensory function of the reconstructed skin flap was evaluated by testing the two-point discrimination using a bipedal gauge.Results:The patients were followed up for 6-24 months [(11.8±5.3)months], and all the flaps survived. At the last follow-up, the flaps were free of any swelling and ulceration, with good texture and no sliding. The Maryland foot function score was (92.8±7.2)points at the last follow-up, which was significantly higher than the preoperative (36.6±6.1)points ( P<0.01), being excellent in 9 patients and good in 3. The two-point discrimination of the reconstructed flap was (17.8±5.7)mm at the last follow-up, and there was no significant difference compared with the contralateral (16.3±5.1)mm ( P>0.05). The sensation of the flap returned to normal. There were residual scars in the flap donor area after skin grafting, but no significant impact on foot movement. Conclusion:The medial plantar flap combined with medial foot flap has a large cutting area and good texture, meets the functional requirements, and achieves good postoperative sense recovery, making it a good choice for the repair of weight-bearing area defects of the foot.

Analysis of the effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects / 中华显微外科杂志

Objective:To retrospectively analyse the clinical effect of sensation reconstructed free medial plantar artery perforator flap in repair of digit-tip defects.Methods:From March 2017 to February 2021, 11 cases with digit-tip defect were repaired by medial plantar artery perforator flap in the Department of Hand Surgery of Xuzhou Renci Hospital. The cutaneous sensory nerves were separated when the flap was harvested, and then the sensory nerves were sutured to the palmar nerves of the digits to reconstruct the sensation of the flap. All wounds had exposure of phalangeal bones, the size of the digit-tip defects was 1.2 cm×1.0 cm-2.5 cm×2.2 cm, the size of the flaps was 1.6 cm×1.5 cm-3.0 cm×2.7 cm. Ten donor sites were directly sutured and 1 was repaired by skin grafting. All patients were included in the postoperative follow-up through outpatient clinic and WeChat reviews to collect relevant information, including texture, sweating, stability, sensation, degree of bloating, blood circulation, usage of the flaps and skin and scars at the donor sites.Results:All flaps survived besides 1 case had venous occlusion occurred 12 hours after the operation, and the venous occlusion was relieved by releasing the dressing and removing some of sutures, and the flap survived smoothly. The wounds in the donor sites healed well. The postoperative follow-up period lasted for 6-18 months, with an average of 10.7 months. The flaps were soft, wear-resistant, and stable. The skin texture was restored with a small amount or normal sweating. One flap had mild bloated, and another flap showed a slightly poor colour of the flap together with a lower temperature. The sensory recovery of the flaps was good, reaching S 3+ or above. The TPD had achieved 6.0-8.5 mm, with an average of 7.1 mm. One patient had concerns in using the affected digit and 3 cases were in protective use of the affected digits. There was no wear and ulcer in the foot donor sites. According to Wang Shuhuan's assessment of flap function and Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the patients in this group were scored excellent in 8 cases and good in 3 cases. Conclusion:The application of free medial plantar artery perforator flap in repair of digit-tip wounds can achieve good repairs. The donor site is hidden without effect on walking. It is one of the ideal donor sites for repairing digit-tip wounds.

Pulp defect of thumb and finger repaired by the medial plantar artery flap: Report of 10 cases / 中华显微外科杂志

Objective:To investigate the effect of using the free medial planar artery flap(MPAF) pedicled by the superficial branch of the medial plantar artery in repair of pulp defect of thumb and finger.Methods:Ten patients with pulp defect of thumb and finger were repaired with MPAF of foot in the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from November 2020 to January 2022. There were 3 cases of cutting injury, 2 cases of chainsaw injury, 2 cases of extrusion injury and 3 cases of avulsion injury. Digits injuried: 4 index fingers, 3 thumbs, 2 middle fingers, and 1 ring finger. After admission, Doppler ultrasound was performed to understand the running course of medial plantar artery. Emergency surgeries were performed to repair the pulp defects of thumb and finger with free MPAF, and donor sites were repaired by skin grafting. The area of soft tissue defects was 2.0 cm×2.5 cm-3.0 cm×4.5 cm, and the size of flap was 2.5 cm×3.0 cm-3.5 cm×5.0 cm after debridement. Postoperative effect was assessed over the follow-up at outpatient clinics by same group of surgeons. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All 10 free MPAFs pedicled by the superficial branch of medial plantar artery survived. After the transfer, the colour, texture and thickness of the flaps were matched with the digit with pulps realistic appearance. Secondary flap thinning surgery was not required. Two cases had blisters at the distal end of the flap, and healed after fluid extraction and dressing change. All patients had 3 to 18 months of follow-up. The TPD of the flap was 4-7 mm. The skin grafts in the donor sites survived well. At the last follow-up, the upper limb function was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with the results of 8 cases in excellent and 2 in good.Conclusion:Free MPAF pedicled by the superficial branch of medial plantar artery can repair the pulp defect of thumb and finger with reliable blood supply, excellent texture and good appearance. And there is no damage to the main vessels in the donor site.

Medial plantar island flap for soft tissue reconstruction of the heel after excision of melanoma / 中华医学美学美容杂志

Objective To study the efficacy of medial plantar island flap for repairing soft tissue defect of the heel after excision of melanoma.Methods Five patients (including 3 males and 2 females) with malignant melanoma were treated.All lesions were located in the heel and were proved by pathological examination.Local extensive resection was performed in all cases.The surgical margin used for excision of melanoma was 2 cm,and the depth used was deep into periosteum of the calcaneus.Plantar medial artery island skin flaps were applied in the reparation according to the size of heel soft tissue defect and anatomic study.The postoperative follow-up was 8 to 14 months.Results The surgical reparation was successful in all 5 cases.The plantar medial artery was very suitable to cover the surgical wound surface and to recover the function and sense.Before 3 months the sense of flaps remained on the donor area and later went to the heel gradually.All patients remained alive and no tumor recurrence was observed.All the patients were walking normally and had protective sensation in the new heel pad comparable to the opposite normal heel.Two patients with more than 10 years follow-up were reported.Conclusions Plantar medial island flap can be used to repair the wound after malignant melanoma resection in the heel,which is an effective method.

Posttraumatic pseudoaneurysm of medial plantar artery in a child: treatment with percutaneous thrombin injection / Pseudoaneurisma pós-traumático de artéria plantar medial em criança: tratamento percutâneo com injeção de trombina

Pseudoaneurysms of the medial plantar artery are rare. The authors describe a case of a pseudoaneurysm of the medial plantar artery of a child who had suffered a penetrating laceration injury. Diagnosis can be confirmed using Doppler ultrasound and magnetic resonance angiography. As an alternative to the conventional surgery technique, percutaneous Doppler ultrasound-guided thrombin injection is a safe and effective treatment.

O pseudoaneurisma da artéria plantar medial é raro. Os autores relatam um caso de pseudoaneurisma da artéria plantar medial após lesão perfurocortante em criança. O diagnóstico pode ser confirmado por ultrassom com Doppler e angiorressonância magnética. Em contraponto à técnica cirúrgica convencional, o tratamento pode ser feito de maneira efetiva e segura com a injeção percutânea de trombina assistida pelo ultrassom com Doppler.

Anatomy basis and clinical significance of various types of abductor hallucis superior margin arterial arcades / Bases anatómicas e importancia clínica de varios tipos de arcos arteriales del margen superior del músculo abductor del hálux

The aim of this study was to group arteries of arterial arch at the superior margin of the abductor hallucis muscle according to their constitutes and provide anatomical basis for reverse bifolicated flap based on it. The constitute, track-way and distribution of the artery, which supply the medial pedis flap, the medial plantar and the medial tarsal flap, especial the arterial arch at the superior margin of the abductor hallucis muscle were observed and analyzed on 81 lower limbs cast specimens and 2 fresh feet specimens. According to their constitute, arterial arch at the superior margin of the abductor hallucis muscle can be classified into 3 types: i) type I, It was constituted mainly by the branch of anterior medial malleolus artery and (or) the medial tarsal artery. ii) type II, It was constituted mainly by the superficial branch of the medial plantar artery; iii) type II, It was constituted mainly by the branch of anterior medial malleolus artery and the branch of medial tarsal artery anastomose with the superficial branch of the medial plantar artery, which was divided into two subtypes according to the different anastomosis of the artery: Type III 1, the type of anastomosed directly was about 48.2 percent, type III 2, The type of anastomosed indirectly was about 24.1 percent. According to the constitute of arterial arch at the superior margin of the abductor hallucis muscle can be classified into three types: The type of anterior medial malleolus artery and medial tarsal artery, the type of superficial branch of the medial plantar artery and the type of mixed. For the type mixed, two subtypes can be classified according to the different anastomosis of the artery.

El objetivo fue clasificar las arterias de arco arterial del margen superior del músculo abductor del hálux según su constitución, y proporcionar una base anatómica para el colgajo bilobulado reverso basado en él. La constitución, recorrido y distribución de las arterias que suministran los colgajos pedicular medial, plantar medial y medial del tarso, en especial el arco arterial del margen superior del músculo abductor del hálux fueron observados y analizados en 81 modelos de miembros inferiores y 2 pies frescos. De acuerdo con su constitución, el arco arterial del margen superior del músculo abductor del hálux se pueden clasificar en 3 tipos: i) tipo I, constituido principalmentepor la rama de la arteria anterior del maléolo medial y/o la arteria medial del tarso. ii) tipo II, constituido principalmente por la rama superficial de la arteria plantar medial, iii) tipo III constituido principalmente por la rama de la arteria maleolar medial anterior y la rama de la anastomosis de la arteria tarsiana medial de la rama superficial de la arteria plantar medial, que se divide en 2 subtipos diferentes de acuerdo con el tipo de anastomosis: tipo III 1, una anastomosis directa que se observó en el 48,2 por ciento, y tipo III 2, una anastomosis indirecta observada en aproximadamente el 24,1 por ciento de los casos. Según la constitución, el arco arterial del margen superior del músculo abductor del hálux se puede clasificar en 3 tipos: el tipo de arteria anterior del maléolo medial y la arteria tarsiana medial, el tipo de rama superficial de la arteria plantar medial y el tipo mixto. En el tipo mixto, pueden ser clasificados 2 subtipos de acuerdo a la diferente anastomosis de la arteria.

Free Flap Coverage of the Finger Defect Caused by Digital Replantation Failure

PURPOSE: In case of the failed replantation, if the patients want to preserve the length of amputated stump, toe transfer is the ideal choice. However, reconstruction of these amputated stump with a free flap can be a useful method when the patients refuse sacrificing their toe. Our purpose of this study is to evaluate availability of functional results and patient satisfaction after this procedure. MATERIALS AND METHODS: From March 2008 to February 2012, we reconstructed the amputated stump with free flap by patients demand. Eleven patients were included, medial plantar artery perforator flap in seven cases and great toe pulp flap in five cases. Follow-up range 12 to 24 months and we evaluate patient satisfaction by using a visual analogue scale (VAS; 1=unsatisfied, 5=excellent) and functional recovery by measuring the range of motion of remaining joint at 12 months after operation. RESULTS: During follow-up period, all transferred free flaps survived and no major complications were noted. Range of motion of remaining joint appeared satisfactory result (15degrees to 100degrees). The VAS patient satisfaction score for aesthetic were five in six patients, four in four patients, and three in one patient. CONCLUSION: In case of the failed digital replantation, if patient refuse toe transfer, it could be useful method to reconstruction with the free flap to preserving maximal length of amputated stump.

Applied anatomy of the medial plantar skin flaps with repairing heel defects and its clinical application / 中华显微外科杂志

@#Objective To explore an anatomical basis for the medial plantar skin flaps and its clinical value of repairing heel defects. Methods The origin,branches,course and distribution of the medial plantar artery and the nerve of flaps were studied in 10 adult cadavers(20 legs).8 cases of homonymy and opposite side heel soft tissue defects with medial plantar skin flaps,aged 10-42 years.Free skin transplantation on the donors. Results The length of media plantar artery deep branch was (8.9±0.2)cm,gives off 3-5 cutaneous branches.Medial plantar nerve have 5-8 branches.it inchdes 3～5cutaneous branches distribute plantar skin and 2-4 plantar digital nerves distribute toes skin.The area of flaps was 4.0 cm×3.0 cm-6.0 cm×5.0 cm in the 8 flaps. 6 pedicle skin flaps were transfenrred to repair homonymy side heel soft tissue defects.2 opposite side heel soft tissue defects were repaired by 2 free flaps.All the flaps were survived. All patients were followed up one months to one year,the function and appearance of the flaps were good.Conclusion The flaps have less anatomic variation or sacrificing major vessels but have reliable blood supply and can restore good sensation after operation.They are ideal flaps for repairing heel soft tissue defects.

Anatomical study and clinical application of free medialis pedis flap based on the top branch of plantaris arch / 中华显微外科杂志

Objectives To observe anatomical location of the top branch of plantaris arch which extends from the superficial branch of the medial plantar artery,design and apply flap base on it. Methods On the basis of the anatomical data from 8 feet of 4 fresh cadavers and probed of the Doppler from 50 feet of normal person,defined the anatomic location and body surface projection of the top branch of plantaris arch,a type of new flap design were introduced in the paper. Results The flaps have been used in six cases clinically to treat skin defect of the hand meanwhile,sensation of the flap was regained by suturing nerve.All flaps survived,the appearance of the flaps were excellent,the function of the injured hands were recovered well. Conclusions The design of the flap is reasonable,it is suitable that the free medialis pedis flap of the top branch of plantaris arch is used to repair a small skin defect of the hand.