Free transplantation of the chimeric flap based on the perforator of the posterior tibial artery for reconstruction of bone and skin defect in extremities / 中华显微外科杂志

ABSTRACT

Objective To investigate the clinical effect of the chimeric flap based on the perforator of the posterior tibial artery for reconstruction of bone and skin defect in extremities.Methods From March,2007 to June,2013,the legs of the patients with bone nonunion,bone defect and skin soft tissue defect in extremities accepted digital subtraction angiography to find the larger perforators in the upper middle section of posterior tibia1 artery.Color doppler flow imaging (CDFI) was used to track branches and directions of the larger perforators and to look for the perforators which gave off secondary branches respectively to the skin and periosteum.According to the length of bone defect and the area of skin defect,the composite flap with the bone flap and skin flap was designed and cut out.It was based on the right single perforator of the posterior tibial artery which was chosen.The free composite flap was called the chimeric flap based on the perforator of the posterior tibial artery and repaired bone and skin defect in extremities.The size of osseous flaps ranged from 1.5 cm × 0.6 cm × 0.4 cm to 4.0 cm × 2.0 cm × 1.0 cm,and the size of cutaneous flaps of total 17 cases ranged from 2.0 cm × 2.0 cm to 7.0 cm × 6.0 cm.Results Followed-up for 3 to 18 months,all osseous flaps and cutaneous flaps survived,and all donor sites healed well.Nine cases of all cutaneous flaps were flat with the surrounding tissue and others bloated,but they were flat with the surrounding tissue after second phase to fat plastic.The fracture line disappeared and bone healed well at the time of 3-6 months after operation of bone graft to repair bone defect.According to the related evaluation criteria made by the Chinese Medical Association,the results of 10 cases of hand trauma patients were excellent in 7 cases,good in 2 cases,may in 1 case.Seven cases of lower leg and foot trauma patients could walk with load without pain.Conclusion Application of the chimeric flap based on the perforator of the posterior tibia1 artery is an ideal method to repair the small pieces of bone defect with skin soft tissue defect caused by various reasons in extremities.Because this kind of surgery doesn't sacrifice known vessels with minimal donor site morbidity,and healing time of the bone graft is short and the bone is not easy to absorb.