Repairing massive soft tissue defects of shank and foot with combined flaps with the help of 3D-CTA technique / 中华显微外科杂志

ABSTRACT

To explore the clinical value of repairing massive soft tissue defects of shank and foot with diverse combined flaps with the help of 3D-CTA technique. Methods From March, 2011 to May, 2018, 7 pa-tients with massive soft tissue defects (defect area21 cm×14 cm-53 cm×16 cm) of shank and foot were treated with combined flaps, including free anterolateral thigh flaps(ALTP) combined with local transferred sural neurocuta-neous vascular flaps in 2 cases, free ALTP combined with local transferred supracondylar flap in 2 cases, free thora-co-umbilical flaps plus local transferred gastrocnemius muscular flaps in 1 case, and free ALTP plus free thoraco-um-bilical flap in 1 case.Free ALTP and free thoraco-umbilical flap respectively combined with double bridge flaps using the both ends of posterior tibial vessel from the healthy limb to form vascular pedicles in 1 case. All cases received 3D-CTA to observe the distribution and anastomosis of perforator vessel. Regular followed-up was made post-opera-tively. Results All patients had been followed-up for 6-18 months. Outpatient service combined with telephone follow-up was adopted. All flaps survived, and flap shape, colour and lustre, elasticity got good recover. At the last follow-up, thermann scale function assessment 4 cases were excellent, 2 were good, and 1 was fair. Conclusion It is a feasible and effective method to repair massive soft tissue defects of shank and foot using differently combined flaps. Although the surgery can be risky, the method can effectively reduce the rate of limb disability, restore the limb func-tion and shorten the course of treatment.Preoperative 3D-CTA can get the vessel anatomical structure and diameter at donor and recipient sites, which will guide the operation program design and implementation so as to shorten the oper-ation time and improve the accuracy rate of vascular anastomosis.