Choices of pedicle skin flaps in repairing cutaneous defects of foot and ankle / 中华显微外科杂志

ABSTRACT

Objective To explore and summarize the choices of pedicle skin flaps in repairing cutaneous defect of foot and ankle.Methods Defects of forefoot,pedal dorsum,pedal plantar and ankle were repaired with pedicle skin flaps such as dorsal pedal flap,medial plantar flap,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal artery flap,anterior ankle artery flap peroneal artery flap etc.Results Except for necrosis of 2 cases of flap,the other 249 flaps all survived.Blood vessel crisis was induced in 5 patients on 1st postoperative day,and in 2 cases on 2nd postoperative day,by tight package of transplanted skin,which was treated by emergent explorative operation.Finally 135 cases got 3 to 96 months' followed up(average of 16 months).There were 4 cases of medial pedal flap and 3 cases of plantar metatarsal flap received secondary reshaping for treating skin wear out.Nine cases of posterior tibial artery flap,and 6 cases of sural nerve flap were reshaped secondarily to improve bulk shape.Other flaps did not need secondary reshaping.Among them,in medial pedal flap,fibular-side flap of hallux,and tibialside flap of 2nd toe,sensory nerve were all transferred together with the flap,and normal sensory was got,with 4-10 mm two point discrimination.Condusion In covering tissue defects on heel or plantar side of forefoot,medial plantar artery flap is ideal.For defects on plantar side of forefoot,plantar metatarsal flap,fibular hallux flap,tibial flap of 2nd toe have the advantages of wear resistance and nerve innervation.While dorsal pedal flap,anterior tibial artery flap,posterior tibial artery flap,sural nerve flap,lateral tarsal flap,anterior ankle artery flap,and peroneal artery perforator flap have the advantages of large size,thinness,similar color with recipient site,and constant anatomical position,they are feasible for repairing defects on dorsum of foot or near ankle.