Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Xi , XU Yongqing , SHI Yan , LIU Wuhua , FANG Xiang ,  HE Xiaoqing

Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

HE Xiaoqing, Email: hxq00@foxmail.com

Keywords：

Propeller flap; perforator flap; lower limb; foot and ankle defect; children

DOI：

10.7507/1002-1892.202110041

Video：

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Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=?11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. Conclusion The perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.

Citation： YANG Xi, XU Yongqing, SHI Yan, LIU Wuhua, FANG Xiang, HE Xiaoqing. Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 329-334. doi: 10.7507/1002-1892.202110041 Copy

1.	Hifny MA, Tohamy AMA, Rabie O, et al. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. Ann Chir Plast Esthet, 2020, 65(1): 54-60.
2.	Onishi T, Shimizu T, Omokawa S, et al. Anatomical study of the popliteal artery perforator-based propeller flap and its clinical application. Plast Reconstr Surg, 2018, 142(2): 548-551.
3.	劉建, 黃凱, 沈立峰, 等. 腓動脈穿支蒂螺旋槳皮瓣修復足踝部軟組織缺損. 中國骨傷. 2016, 29(12): 1088-1091.
4.	?zalp B, Ayd?nol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
5.	董云飛, 陶忠生, 吳清華, 等. 不同方法修復兒童足跟輪輻傷皮膚缺損伴跟腱外露. 臨床骨科雜志, 2021, 24(1): 64-67.
6.	朱躍良, 殷作明, 范新宇, 等. 小腿受區血管缺乏時重建梯的研究. 中華顯微外科雜志, 2017, 40(4): 328-332.
7.	甘干達, 扈克治, 唐繼全, 等. 應用4種皮瓣修復小兒足跟部軟組織缺損的臨床效果. 創傷外科雜志, 2012, 14(3): 202-205.
8.	劉毅. 重視供區的美容修復. 中華燒傷雜志, 2020, 36(2): 81-84.
9.	唐舉玉, 汪華僑, Hallock GG, 等. 關注皮瓣供區問題——減少皮瓣供區損害專家共識. 中華顯微外科雜志, 2018, 41(1): 3-5.
10.	Abdelmegeed AG, Abulezz TA, Abo-Saeda MA, et al. Perforator-based pedicled cross-leg flaps in pediatric patients: A new idea to increase flap reach. Ann Plast Surg, 2021, 86(5): 568-572.
11.	王軍, 印飛, 鄒成達, 等. 不攜帶一級源血管的游離股前外側穿支皮瓣修復兒童足跟部輪輻傷. 中華手外科雜志, 2020, 36(4): 244-246.
12.	古欣慶, 周洋, 朱紅亮, 等. 削薄股前外側皮瓣在兒童足踝部軟組織缺損中的應用. 實用手外科雜志, 2021, 35(2): 173-176.
13.	徐永清, 何曉清, 朱躍良, 等. 股前外側皮瓣在兒童四肢創面修復中的應用. 中華創傷雜志, 2018, 34(10): 875-880.
14.	曹文亮, 田峰, 田立杰. 腓動脈踝上穿支皮瓣修復兒童足踝部皮膚軟組織缺損八例. 中華顯微外科雜志, 2018, 41(4): 380-383.
15.	鄧葵, 黃跟東, 陳明, 等. 腓動脈穿支皮瓣修復兒童足跟部嚴重輪輻傷. 中華顯微外科雜志, 2018, 41(2): 145-147.
16.	唐舉玉, 俞芳, 吳攀峰, 等. 脛后動脈穿支螺旋槳皮瓣修復兒童足跟部輪輻傷. 中華整形外科雜志, 2018, 34(8): 636-639.
17.	何曉清, 朱躍良, 徐永清, 等. 兒童足后跟Ⅲ級輪輻傷后跟腱重建中帶蒂皮瓣選擇. 中華創傷雜志, 2016, 32(5): 434-439.
18.	徐永清, 柴益民, 張世民, 等. 穿支螺旋槳皮瓣專家共識. 中華顯微外科雜志, 2019, 42(5): 417-422.
19.	Kang JS, Choi HJ, Tak MS. Reconstruction of heel with propeller flap in postfasciotomy and popliteal artery revascularization state. Int J Low Extrem Wounds, 2016, 15(2): 132-135.
20.	Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plast Reconstr Surg, 2016, 137(1): 314-331.
21.	崔軼, 李國棟, 楊曦, 等. CTA聯合手持彩色多普勒超聲設計小腿穿支螺旋槳皮瓣的臨床應用. 中華顯微外科雜志, 2019, 42(3): 232-236.
22.	趙萬秋, 徐永清, 何曉清, 等. 數字化技術在腓動脈穿支蒂螺旋槳皮瓣修復足跟部創面中的臨床應用. 中國修復重建外科雜志, 2020, 34(3): 367-372.
23.	Cajozzo M, Jiga LP, Jandali Z, et al. Complications and solutions in propeller flap surgery. Semin Plast Surg, 2020, 34(3): 210-220.
24.	Wang P, Lin F, Ma Y, et al. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskelet Disord, 2021, 22(1): 643. doi: 10.1186/s12891-021-04522-z.
25.	Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
26.	Zang M, Zhu S, Chen B, et al. Perforator propeller flap “relay” for distal lower extremity soft tissue reconstruction. J Foot Ankle Surg, 2020, 59(5): 1128-1132.
27.	王偉, 李俊明, 代鵬威, 等. 脛前動脈穿支螺旋槳皮瓣接力腓動脈終末前穿支螺旋槳皮瓣修復足踝部創面. 中國修復重建外科雜志, 2020, 34(1): 87-91.
28.	Zhong W, Lu S, Wang C, et al. Single perforator greater saphenous neuro-veno-fasciocutaneous propeller flaps for lower extremity reconstructions. ANZ J Surg, 2017, 87(7-8): E40-E45.
29.	許育健, 何曉清, 徐永清, 等. 基于下肢CT血管成像的腘動脈分支變異的解剖學研究. 中華解剖與臨床雜志, 2020, 25(5): 472-477.

1. Hifny MA, Tohamy AMA, Rabie O, et al. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. Ann Chir Plast Esthet, 2020, 65(1): 54-60.
2. Onishi T, Shimizu T, Omokawa S, et al. Anatomical study of the popliteal artery perforator-based propeller flap and its clinical application. Plast Reconstr Surg, 2018, 142(2): 548-551.
3. 劉建, 黃凱, 沈立峰, 等. 腓動脈穿支蒂螺旋槳皮瓣修復足踝部軟組織缺損. 中國骨傷. 2016, 29(12): 1088-1091.
4. ?zalp B, Ayd?nol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
5. 董云飛, 陶忠生, 吳清華, 等. 不同方法修復兒童足跟輪輻傷皮膚缺損伴跟腱外露. 臨床骨科雜志, 2021, 24(1): 64-67.
6. 朱躍良, 殷作明, 范新宇, 等. 小腿受區血管缺乏時重建梯的研究. 中華顯微外科雜志, 2017, 40(4): 328-332.
7. 甘干達, 扈克治, 唐繼全, 等. 應用4種皮瓣修復小兒足跟部軟組織缺損的臨床效果. 創傷外科雜志, 2012, 14(3): 202-205.
8. 劉毅. 重視供區的美容修復. 中華燒傷雜志, 2020, 36(2): 81-84.
9. 唐舉玉, 汪華僑, Hallock GG, 等. 關注皮瓣供區問題——減少皮瓣供區損害專家共識. 中華顯微外科雜志, 2018, 41(1): 3-5.
10. Abdelmegeed AG, Abulezz TA, Abo-Saeda MA, et al. Perforator-based pedicled cross-leg flaps in pediatric patients: A new idea to increase flap reach. Ann Plast Surg, 2021, 86(5): 568-572.
11. 王軍, 印飛, 鄒成達, 等. 不攜帶一級源血管的游離股前外側穿支皮瓣修復兒童足跟部輪輻傷. 中華手外科雜志, 2020, 36(4): 244-246.
12. 古欣慶, 周洋, 朱紅亮, 等. 削薄股前外側皮瓣在兒童足踝部軟組織缺損中的應用. 實用手外科雜志, 2021, 35(2): 173-176.
13. 徐永清, 何曉清, 朱躍良, 等. 股前外側皮瓣在兒童四肢創面修復中的應用. 中華創傷雜志, 2018, 34(10): 875-880.
14. 曹文亮, 田峰, 田立杰. 腓動脈踝上穿支皮瓣修復兒童足踝部皮膚軟組織缺損八例. 中華顯微外科雜志, 2018, 41(4): 380-383.
15. 鄧葵, 黃跟東, 陳明, 等. 腓動脈穿支皮瓣修復兒童足跟部嚴重輪輻傷. 中華顯微外科雜志, 2018, 41(2): 145-147.
16. 唐舉玉, 俞芳, 吳攀峰, 等. 脛后動脈穿支螺旋槳皮瓣修復兒童足跟部輪輻傷. 中華整形外科雜志, 2018, 34(8): 636-639.
17. 何曉清, 朱躍良, 徐永清, 等. 兒童足后跟Ⅲ級輪輻傷后跟腱重建中帶蒂皮瓣選擇. 中華創傷雜志, 2016, 32(5): 434-439.
18. 徐永清, 柴益民, 張世民, 等. 穿支螺旋槳皮瓣專家共識. 中華顯微外科雜志, 2019, 42(5): 417-422.
19. Kang JS, Choi HJ, Tak MS. Reconstruction of heel with propeller flap in postfasciotomy and popliteal artery revascularization state. Int J Low Extrem Wounds, 2016, 15(2): 132-135.
20. Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plast Reconstr Surg, 2016, 137(1): 314-331.
21. 崔軼, 李國棟, 楊曦, 等. CTA聯合手持彩色多普勒超聲設計小腿穿支螺旋槳皮瓣的臨床應用. 中華顯微外科雜志, 2019, 42(3): 232-236.
22. 趙萬秋, 徐永清, 何曉清, 等. 數字化技術在腓動脈穿支蒂螺旋槳皮瓣修復足跟部創面中的臨床應用. 中國修復重建外科雜志, 2020, 34(3): 367-372.
23. Cajozzo M, Jiga LP, Jandali Z, et al. Complications and solutions in propeller flap surgery. Semin Plast Surg, 2020, 34(3): 210-220.
24. Wang P, Lin F, Ma Y, et al. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskelet Disord, 2021, 22(1): 643. doi: 10.1186/s12891-021-04522-z.
25. Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
26. Zang M, Zhu S, Chen B, et al. Perforator propeller flap “relay” for distal lower extremity soft tissue reconstruction. J Foot Ankle Surg, 2020, 59(5): 1128-1132.
27. 王偉, 李俊明, 代鵬威, 等. 脛前動脈穿支螺旋槳皮瓣接力腓動脈終末前穿支螺旋槳皮瓣修復足踝部創面. 中國修復重建外科雜志, 2020, 34(1): 87-91.
28. Zhong W, Lu S, Wang C, et al. Single perforator greater saphenous neuro-veno-fasciocutaneous propeller flaps for lower extremity reconstructions. ANZ J Surg, 2017, 87(7-8): E40-E45.
29. 許育健, 何曉清, 徐永清, 等. 基于下肢CT血管成像的腘動脈分支變異的解剖學研究. 中華解剖與臨床雜志, 2020, 25(5): 472-477.

Chinese Journal of Reparative and Reconstructive Surgery

Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children

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