APPLICATION VALUE OF DIGITAL SUBTRACTION ANGIOGRAPHY IN REPAIR OF FOOT AND ANKLE WOUNDS WITH POSTERIOR TIBIAL ARTERIAL PERFORATOR FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGZiyang , ZHANGWenduo ,  WEIZairong , WUBihua , LIHai , SUNGuangfeng , JINWenhu , TANGXiujun , DENGChengliang , NIEKaiyu

Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000, P. R. China;

Corresponding?author：

WEIZairong, Email: zairongwei@sina.com

Keywords：

Digital subtraction angiography; Perforator flap; Posterior tibial artery; Foot and ankle wounds

DOI：

10.7507/1002-1892.20150240

Video：

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Objective To explore the application value of digital subtraction angiography (DSA) in repairing foot and ankle wounds with posterior tibial arterial perforator flaps. Methods Between January 2010 and May 2014, 12 cases of foot and ankle wounds were repaired using posterior tibial arterial perforator flaps. There were 7 males and 5 females with an average age of 36 years (range, 22-54 years). The causes were machine injury in 2 cases, falling injury in 3 cases, and traffic accident injury in 7 cases. The disease duration ranged from 7 to 45 days (mean, 16 days). The size of wound ranged from 6 cm×4 cm to 10 cm×5 cm. Preoperative DSA was performed to observe the orientation and distribution of the posterior tibial arterial perforator and the relationship between perforator vessels. Correspondently, the flaps were designed and harvested. The size of flap ranged from 7 cm×5 cm to 11 cm×6 cm. The donor sites were repaired with skin grafts. Results Posterior tibial arterial perforator vessels send out ascending branches and descending branches while going down in the superficial layer. All branches were connected to form vertical chain-form anastamosis, and its orientation was consistent with limb vertical axis. According to DSA results, the flaps were designed and harvested easily. All flaps survived after operation. Meanwhile, wounds healed by first intention. All skin grafts at donor site survived. All patients were followed up 6 months. The flaps had good appearance, color, and texture. No ulcer was found. Affected feet had normal walking function. Conclusion The size, distribution, and chain-form anastamosis condition of the posterior tibial arterial perforator vessels can be accurately observed by DSA, which provides imaging evidence for harvesting posterior tibial arterial perforator flaps and improves the success rate for repairing foot and ankle wounds.

Citation： ZHANGZiyang, ZHANGWenduo, WEIZairong, WUBihua, LIHai, SUNGuangfeng, JINWenhu, TANGXiujun, DENGChengliang, NIEKaiyu. APPLICATION VALUE OF DIGITAL SUBTRACTION ANGIOGRAPHY IN REPAIR OF FOOT AND ANKLE WOUNDS WITH POSTERIOR TIBIAL ARTERIAL PERFORATOR FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(9): 1109-1112. doi: 10.7507/1002-1892.20150240 Copy

1.	黃鏗, 舒申友, 謝揚, 等. 脛后動脈穿支皮瓣修復足踝部組織缺損 12例. 中華顯微外科雜志, 2014, 37(4):387-388.
2.	張功林, 陳克明, 趙來緒, 等. 脛后動脈穿支皮瓣帶神經修復小兒足跟軟組織缺損. 中華小兒外科雜志, 2012, 33(2):122-125.
3.	顧加祥, 潘俊博, 劉宏君, 等. 游離股前外側動脈穿支皮瓣及腓動脈穿支皮瓣在足踝部創面中的應用. 中國修復重建外科雜志, 2013, 27(6):765-766.
4.	Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg, 1985, 76(3):354-363.
5.	Jones EB, Cronwright K, Lalbahadur A. Anatomical studies and five years clinical experience with the distally based medial fasciocutaneous flap of the lower leg. Br J Plast Surg, 1993, 46(8): 639-643.
6.	張發惠, 鄭和平, 宋一平, 等. 內踝區動脈網的顯微解剖與隱神經營養血管遠端蒂皮瓣的設計. 中國臨床解剖學雜志, 2004, 22(6): 568-572.
7.	Amarente J, Costa H, Reis J, et al. A new distally based fasciocutaneous flap of the leg. Br J Plast Surg, 1986, 39(3):338-340.
8.	趙民, 李然, 李大村, 等. 足踝部皮膚軟組織缺損的修復. 中國修復重建外科雜志, 2012, 26(2):255-256.
9.	張天華, 魏在榮. 脛后動脈穿支皮瓣的解剖與臨床研究進展. 中國臨床解剖學雜志, 2014, 32(2):231-233.
10.	卿黎明, 胡懿郃, 唐舉玉, 等. 基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究. 中國修復重建外科雜志, 2014, 28(6):697-700.
11.	張磊, 暢堅, 吳云, 等. 對比增強MR血管成像診斷糖尿病下肢動脈閉塞癥膝以下動脈狹窄的價值. 中華放射學雜志, 2014, 48(8): 664-669.
12.	王強, 牛玉軍. CTA與DSA評價煙霧病血管狹窄程度的對比研究. 中國臨床醫學影像雜志, 2015, 26(2):128-130.
13.	Tang M, Mao Y, Almutairi K, et al. Three-dimensional analysis of perforators of the posterior leg. Plast Reconstr Surg, 2009, 123(6): 1729-1738.
14.	Tajsic N, Winkel R, Husum H. Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes. Injury, 2014, 45(3): 469-477.
15.	Vaienti L, Gazzola R, Benanti E, et al. Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma:the rolnegative-pressure wound therapy. J Orthop Traumatol, 2013, 14(3):213-217.
16.	歐陽海洋, 牟勇, 吳偉熾, 等. 足內側穿支皮瓣設計的解剖基礎. 中國臨床解剖學雜志, 2014, 32(2):141-144.
17.	牛國慶, 黃東, 吳偉熾, 等. 腓動脈雙穿支皮瓣設計的解剖學分析與臨床應用. 中國臨床解剖學雜志, 2014, 32(1):1-4.
18.	吳必華, 魏在榮, 唐修俊, 等. 脛后動脈穿支蒂混合供血皮瓣修復兒童小腿創面. 中華小兒外科雜志, 2013, 34(5):349-352.

1. 黃鏗, 舒申友, 謝揚, 等. 脛后動脈穿支皮瓣修復足踝部組織缺損 12例. 中華顯微外科雜志, 2014, 37(4):387-388.
2. 張功林, 陳克明, 趙來緒, 等. 脛后動脈穿支皮瓣帶神經修復小兒足跟軟組織缺損. 中華小兒外科雜志, 2012, 33(2):122-125.
3. 顧加祥, 潘俊博, 劉宏君, 等. 游離股前外側動脈穿支皮瓣及腓動脈穿支皮瓣在足踝部創面中的應用. 中國修復重建外科雜志, 2013, 27(6):765-766.
4. Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg, 1985, 76(3):354-363.
5. Jones EB, Cronwright K, Lalbahadur A. Anatomical studies and five years clinical experience with the distally based medial fasciocutaneous flap of the lower leg. Br J Plast Surg, 1993, 46(8): 639-643.
6. 張發惠, 鄭和平, 宋一平, 等. 內踝區動脈網的顯微解剖與隱神經營養血管遠端蒂皮瓣的設計. 中國臨床解剖學雜志, 2004, 22(6): 568-572.
7. Amarente J, Costa H, Reis J, et al. A new distally based fasciocutaneous flap of the leg. Br J Plast Surg, 1986, 39(3):338-340.
8. 趙民, 李然, 李大村, 等. 足踝部皮膚軟組織缺損的修復. 中國修復重建外科雜志, 2012, 26(2):255-256.
9. 張天華, 魏在榮. 脛后動脈穿支皮瓣的解剖與臨床研究進展. 中國臨床解剖學雜志, 2014, 32(2):231-233.
10. 卿黎明, 胡懿郃, 唐舉玉, 等. 基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究. 中國修復重建外科雜志, 2014, 28(6):697-700.
11. 張磊, 暢堅, 吳云, 等. 對比增強MR血管成像診斷糖尿病下肢動脈閉塞癥膝以下動脈狹窄的價值. 中華放射學雜志, 2014, 48(8): 664-669.
12. 王強, 牛玉軍. CTA與DSA評價煙霧病血管狹窄程度的對比研究. 中國臨床醫學影像雜志, 2015, 26(2):128-130.
13. Tang M, Mao Y, Almutairi K, et al. Three-dimensional analysis of perforators of the posterior leg. Plast Reconstr Surg, 2009, 123(6): 1729-1738.
14. Tajsic N, Winkel R, Husum H. Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes. Injury, 2014, 45(3): 469-477.
15. Vaienti L, Gazzola R, Benanti E, et al. Failure by congestion of pedicled and free flaps for reconstruction of lower limbs after trauma:the rolnegative-pressure wound therapy. J Orthop Traumatol, 2013, 14(3):213-217.
16. 歐陽海洋, 牟勇, 吳偉熾, 等. 足內側穿支皮瓣設計的解剖基礎. 中國臨床解剖學雜志, 2014, 32(2):141-144.
17. 牛國慶, 黃東, 吳偉熾, 等. 腓動脈雙穿支皮瓣設計的解剖學分析與臨床應用. 中國臨床解剖學雜志, 2014, 32(1):1-4.
18. 吳必華, 魏在榮, 唐修俊, 等. 脛后動脈穿支蒂混合供血皮瓣修復兒童小腿創面. 中華小兒外科雜志, 2013, 34(5):349-352.

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APPLICATION VALUE OF DIGITAL SUBTRACTION ANGIOGRAPHY IN REPAIR OF FOOT AND ANKLE WOUNDS WITH POSTERIOR TIBIAL ARTERIAL PERFORATOR FLAP

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