RESUMO
Objective:To summarise the clinical application and results of superficial peroneal artery perforator flaps in tiled reconstruction of thumbs and fingers.Methods:From June 2020 to June 2022, 8 patients with finger or thumb defects (4 thumbs, 2 index fingers and 2 middle fingers) received digit reconstruction in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital. Two thumbs (2 patients) were reconstructed with a free partial hallux nail flap combined with a free perforator flap of superficial peroneal artery and an iliac bone graft, 1 thumb was reconstructed with a free partial hallux nail flap combined with a free perforator flap of superficial peroneal artery, 1 thumb and 2 middle fingers were reconstructed with free perforator flaps of superficial peroneal artery combined with iliac bone grafts, and 2 index fingers were reconstructed with lobulated free perforator flaps of superficial peroneal artery. The sizes of the flaps were 1.8 cm×3.2 cm-4.0 cm×10.0 cm. Lengths of iliac crest were 1.5-4.0 cm. The donor sites were directly sutured in 5 patients, skin grafts in 2 and superficial peroneal artery perforator flap reconstruction in 1 patient. Postoperative observations included survival of the digits and healing of the bone grafts. Monthly scheduled postoperative follow-ups were conducted at outpatient clinics and via telephone or WeChat reviews, covering function and appearance of the reconstructed digits, impact on the function and appearance of donor sites as well as the satisfaction of patients.Results:All 8 reconstructed digits survived in one stage and all the 5 bone grafts healed at 3 to 4 months after surgery. The mean postoperative follow-up period was 10 months, ranged 4 to 20 months. The texture of the reconstructed digits was close to that of the recipient site and good in elasticity, without purplish while in cold, nor ulceration, obvious bloating and pigmentation. Sensation of the digit pulps was recovered to S 2 to S 3, and the sensation in touch, pain and temperature were restored. TPD was not checked. There was no noticeable hyperplasia nor pain in the recipient and donor sites. There was no obvious hyperplasia or pain at the donor sites for the hallux nail flap, and the skin grafts or flaps in the donor sites survived well without ulceration or pain and the function of the donor feet were not affected. Functions of the reconstructed digits were assessed according to the Functional Assessment Criteria for Thumb and Finger Reconstruction of the Society for Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 4 patients achieved in excellent and 4 in good. According to the University of Michigan Hand Profile Questionnaire (MHQ), patient satisfaction was found very satisfied with 4 patients and satisfied with the other 4 patients. Conclusion:The superficial peroneal artery perforator flap has advantages of thin and large area with pleasant texture, better sensation recovery and less damage to the donor site. It is an ideal flap for reconstruction of thumbs and fingers.
RESUMO
Objective:To explore the surgical method and clinical effect of harvesting 2 ipsilateral free pedicled perforator flaps from a single donor site of superficial peroneal artery in reconstruction of 2 defects in same or adjacent digits.Methods:From November 2017 to August 2021, 12 patients with 2 defects in same or adjacent digits were treated in the Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital with 2 ipsilateral free pedicled perforator flaps from a single donor site of superficial peroneal artery. Among the patients, 1 had the defect in dorsal and palmar of index finger, 1 in thumb and index finger, 6 in index and middle fingers, 3 in middle and ring fingers, and 1 in ring and little fingers. The size of digit defects was 1.5 cm×0.8 cm-6.0 cm×3.5 cm. The size of flaps was 2.0 cm× 1.2 cm-8.0 cm×4.0 cm. All the patients were included in postoperative monthly follow-up to assess the recovery of recipient and donor sites at outpatient service, by telephone or WeChat.Results:All 24 flaps in 12 patients survived without vascular compromise and achieved 100% of survival rate. The follow-up period ranged from 4 to 18 months, with an average of 10 months. Six patients were treated with additional flap thinning and plastic surgery at 4 months after the primary surgery due to slightly bloated flaps. Otherwise, all the flaps in the recipient site had neither pigmentation, obvious hyperplasia nor scar pain. All flaps gained the protective sensations, however the assessment of TPD was not conducted. The flaps were wear-resist and had no ulceration. The texture of the flaps was soft with good elasticity, and the flap did not turn to purple or swelling when in cold. The functional recovery of 23 digits in 12 patients was evaluated according to the total active mobility (TAM) of the digits. It achieved excellent in 3 digits, good in 15 digits, and fair in 5 digits, with an excellent and good rate of 78.26%. A linear scar appeared at the donor site without obvious hyperplasia or scar pain. There were normal sensations around the scar and at the digit-tips. The blood supply to the digit-tips was normal.Conclusion:Harvest of multiple free pedicled perforator flaps from a single donor site of superficial peroneal artery is an effective method in reconstruction of 2 defects in same or adjacent digits at the same time. It has advantages of being a simple surgery procedure by sacrificing only one donor site. It achieves a minimal damage to the donor site and a reliable blood supply of the flap.
RESUMO
Objective:To explore the surgical procedure and clinical effect of the free Flow-through superficial peroneal artery flap for repairing the digit injury with defect of proper palmar digital artery.Methods:From June, 2015 to December, 2019, free Flow-through superficial peroneal artery flap was used to repair the digit injury and to bridge the proper digital artery in 7 digits of 7 patients. There were 2 thumbs, 3 index fingers and 2 middle fingers. The size of defects on digits ranged from 2.5 cm×3.0 cm to 5.0 cm×7.0 cm. The defects of digit proper artery were 1.0 to 3.0 cm. The size of flaps was from 3.0 cm×3.5 cm to 5.5 cm×8.0 cm. The donor areas of the flap were directly sutured or covered with skin graft. Postoperative supportive treatments were given, such as infection prevention, antispasmodic, anticoagulant, analgesia and fluid infusion. The patients were kept in bed for 1 week after surgery. Monthly follow-up review were conducted and the patients were kept with the rehabilitation exercises under medical guidance.Results:All the patients entered postoperative followed-up for 6 to 18 months, with an average of 8 months. All flaps survived without any adverse event. All wounds achieved stage-one-healing. The flaps appeared in good colour, texture, elasticity and the plumps of the digit without obvious bloating. There was no obvious swelling and atrophy of the digits. The skin temperature was normal. According to the Standard for Evaluation of Upper Limb Function by the Hand Surgery Society of Chinese Medical Association, 3 digits were excellent and 4 were good. There was no obvious scar at the donor site of shank. The donor site had a good appearance and the limb function was not affected.Conclusion:The free Flow-through superficial peroneal artery flap is an ideal material to repair the defect of digit with the defect of proper digital artery. It has the advantages of simple surgical procedure, reliable blood supply and satisfactory appearance. The defect of proper digit artery can be repaired at the same time of the surgical procedure. The blood supply, appearance and function of the digits could be well recovered and the donor site is not affected.
RESUMO
Objective@#To explore the effects of multiple free homologous superficial peroneal artery perforator flaps of crus for repair of multiple hand wounds.@*Methods@#From November 2017 to December 2018, eight cases with eighteen hand wounds were hospitalized in our unit. Among them, wounds were distributed in the forefinger and middle finger in four cases, wounds were distributed in the middle finger and ring finger in two cases, wounds were distributed in the forefinger, middle finger, and ring finger in one case, and wounds were distributed in the middle finger, ring finger, and little finger in one case. The area of skin defect ranged from 1.5 cm×0.8 cm to 4.0 cm×3.0 cm. There were 4 males and 4 females, aged 34-62 years. Wounds of six cases were repaired by two free superficial peroneal artery perforator flaps from homolateral crus, and those of two cases were repaired by three free superficial peroneal artery perforator flaps from homolateral crus. Superficial peroneal artery and its accompanying vein of flap were anastomosed by end to end with digital artery and palmar or dorsal subcutaneous vein of recipient site during the operation. The area of flap ranged from 2.5 cm×1.2 cm to 5.0 cm×4.0 cm. No nerve was harvested during the operation, and donor site was sutured directly. The survival of the flaps and the healing of donor sites were recorded. During follow-up, the recovery of donor and recipient sites was observed.@*Results@#All flaps survived well, donor site healed well. No vascular crisis occurred. Follow-up for 4 to 12 months showed that the appearance of flap was satisfactory with good color, texture, elasticity, and function. Protective sensation of recipient site was recovered. Five months after operation, flap of finger pulp in one case was swollen slightly with two-points discrimination of 10 mm, which received the thinning surgery. Obvious scar formation was not observed in donor site of crus. The appearance of the donor site was good without functional damage.@*Conclusions@#The application of multiple free homologous superficial peroneal artery perforator flaps of crus to repair the multiple hand wounds has advantages of easy acquisition, easy operation, little effect on donor sites, and satisfactory clinical effects.
RESUMO
Objective To investigate the clinical effect of free ultra-thin superficial peroneal artery perforator flap for repairing the wound in forefoot.Methods From January 2010 to June 2012,six cases were treated with free ultra-thin superficial peroneal artery perforator flap for repairing the wound in forefoot,including 4 cases of dorsal defect,two cases of wound on the toe.The size of the wound ranged from 3.0 cm × 5.0 cm 5.5 cm × 8.0 cm.Four cases for direct suture,two cases of donor site repairing with skin graft.Results All of 6 cases were repaired successfully and no vascular crisis occurred,and clinical follow ups were performed after 3-12 months,the results was satisfactory.Conclusion It is an effective method of repairing the wound in forefoot by free ultra-thin superficial peroneal artery perforator flap.
RESUMO
ObjectiveTo explore the clinical efficacy of minitype vascularized superficial peroneal artery's singleness perforator flap,and then to accurately repair skin and soft tissue defects of hands and foots. MethodsFrom November 2009 to January 2011,eight cases(one case of left foot,one case of right foot,three cases of left hand and 3 cases of right band,1.3 cm × 5.0 cm - 2.5 cm× 6.0 cm of skin and soft tissue defects)were treated by minitype vascularized superficial peroneal artery's singleness perforator flap.Based on preoperative applied anatomy papers, it was the superficial peroneal artery's perforator position in the middle of the lateral lower leg to the fibula head;We designed the flap based on the size and shape of skin defect,and then to analysize the flap design,lap cut,he vascular anastomosis of flap and recipient,effect and characteristics of survival. ResultsAll the flaps(1.5 cm × 5.2 cm-2.8 cm × 6.2 cm) survived and satified in shape and texture, they acquired good functional recovery postoperation;There was blister,dark purple but survival after the scab off on 1 patient;There was phalanx ostomyelitis and healed after treatment on 1 patient.ConclusionThe clinical effects were satisfactory for repairing small skin and soft tissue defect of hands and foots by minitype vascularized superficial artery's singleness perforator flap.
RESUMO
Objective To introduce the clinical application of the extended anterolateral leg flap,which is based on the superficial peroneal artery and lateral supramalleolar artery. Methods Through anatomic study on the blood supplies of the skin over the anterolateral portion of the leg.The combined superficial peroneal artery and lateral supramalleolar artery could extend the size of the traditional anterolateral leg flap.In addition,the point of pivot of the extended anterolateral leg flap could locate at the level of the lateral malleolus,which decreases the distance between the flap and recipient site.Clinically,we have used the extended anterolateral leg flaps in 60 patients to cover skin defect over the feet.The flap ranged from 16 cm×10 cm(pedicle length 8.0 cm)to 26 cm×7 cm(pedicle length 6.0 cm). Results In the series, the flap survived in 53 patients(88.3%)unevently,and partial necrosis occurred in 7 patients(11.7%).Conclusion Based on the combined superficial peroneal artery and lateral supramalleolar artery,the size of the traditional anterolateral leg flap could be inceased,which enlarges its value on the coverage of skin defects over the feet.