Modified sural neurocutaneous vascular flap based on single dominant perforator arising from peroneal artery for coverage of defects over Achilles tendon / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of specially designed sural neurocutaneous vascular flap pedicled on a dominant perforator (the diameter > or = 0.8 mm) of the peroneal artery for coverage of soft tissue defects overlying the Achilles tendon.</p><p><b>METHODS</b>An approximately rectangular sural neurocutaneous vascular flap pedicled on the lowest dominant perforator arising from the peroneal artery was designed and harvested to repair defects over the Achilles tendon. The pedicle was located at a certain part of the flap, which divided the flap into the distal and the proximal parts. After the tendon was repaired, the flap was rotated 180 degrees based on the perforator and the position of the distal and proximal parts of the flap was changed to cover the defects and part of the donor site respectively. In most cases, skin graft was not needed.</p><p><b>RESULTS</b>The modified flaps were applied in 15 cases. All flaps (ranged from 13 cm x 15 cm - 18 cm x 9 cm ) were transplanted successfully without necrosis, and no vascular problems occurred. Following up for 10-17 months showed both satisfactory functional and cosmetic results.</p><p><b>CONCLUSIONS</b>The modified flap has reliable blood supply and the special design provides nearly normal outline of the ankle which favorites shoe wearing. It' s an excellent option for covering defects overlying the Achilles tendon.</p>

Study of distribution of dominant perforators arising from peroneal artery with color Doppler flow imaging and its clinical significance for sural neurocutaneous flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap.</p><p><b>METHODS</b>The dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques.</p><p><b>RESULTS</b>The average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%.</p><p><b>CONCLUSIONS</b>According to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.</p>

Modified superficial peroneal neurocutaneous flap pedicled with lateral supramalleolar artery arising from peroneal artery for forefoot defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of modified distally based superficial peroneal neurocutaneous flap for skin defect of the forefoot.</p><p><b>METHODS</b>A reversed superficial peroneal neurocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot.</p><p><b>RESULTS</b>The modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm x 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput.</p><p><b>CONCLUSIONS</b>The modified flap has reliable blood supply with a relatively large size and long rotation arc. It is a simple and safe for covering medium to large defects in the forefoot.</p>

Free peroneal artery perforator sural neurocutaneous flap for hand and foot defects / 中华整形外科杂志

<p><b>OBJECTIVE</b>To report the operative techniques and clinical results of the free peroneal artery perforator sural neurocutaneous flaps.</p><p><b>METHODS</b>Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomosed with a branch of a nearby artery, and the small saphenous vein was anastomosed with the cephalic vein or the great saphenous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap.</p><p><b>RESULTS</b>From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 cm x 7 cm to 18 cm x 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 to approximately 12 mm.</p><p><b>CONCLUSIONS</b>The flap has all the advantages of the free flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.</p>