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REVERSED SURAL NEUROVASCULAR FASCIO-CUTANEOUS FLAP FOR RECONSTRUCTION OF SOFT-TISSUE DEFECTS IN ANKLE AND FOOT

Objective To evaluate clinical significance of reversed sural neurovascular fasciocutaneous flap for reconstruction of softtissue defects in ankle and foot. Methods From July 1994 to December 2002, 52 cases of soft-tissuedefects in the ankle and foot were reconstructed by use of reversed sural neurovascular fascio-cutaneous flap, including 47 cases of traumatic defects, 3 cases of chronic ulcer and 2 cases of tumors. The flap area ranged from 4 cm×6 cm to 10 cm×21 cm. Results The flaps survived in 48 cases; the distal part necrosed and secondary free-skin graft were further conducted in 4 cases. All soft-tissue defects were repaired and their accompanied bone and tendon exposurehealed. Forty-six cases were followed-up for 5 months to 48 months, the color and texture of the flaps were excellent and 2point discrimination was 11-17 mm(14 mm on average).The functions of ankle joints were good.Conclusion The reversedsural neurovascular fascio-cutaneous flap is convenient in design and dissection. Its use can retained and replace vascular anostomosed flaps to certain degrees.

CLINICAL APPLICATION OF IMPROVED ISLAND SKIN FLAP WITH DISTALLYBASED SURAL NERVE NUTRIENT VESSELS

Objective To report the clinical result of the improvedisland skin flap with distallybased sural nerve nutrient vessels in repairing skin defect in the heel, ankle or foot. Methods From August2004 to April 2005, 15 patients with skin defect in the heel, ankle or foot at distal part were treated by the improved island skin flap with distally-based of sural nerve nutrient vessels. Of 15 flaps, 12 were simplex flaps and 3 were complex flaps. These flap area ranged from 7 cm×6 cm to 11×8 cm. The donor sites were sutured directly and covered with free flap. Results All flaps survived without flap swelling and disturbance of blood circulation. The wounds of donor and recipient sites healed by first intention. The followup period ranged from 3 to 6 months. The texture of flap was soft and the color of flap was similar to that of normal skin. The foot function was excellent. Conclusion The improved island skin flap with distally-based sural nerve nutrient vessels is an ideal skin flap for repairing skin defect in the heel, ankle or foot distal part in clinical. The operation is simple and need not to anastomose blood vessel.

FREE VASCULARIZED POPLITEAL ARTERY CUTANEOUS BRANCH FLAP FOR REPAIR OF WOUND ON FOOT AND ANKLE

ObjectiveTo investigate the feasibility and effectiveness of free popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein for the repair of wound on the foot and ankle by anatomical observation and clinical application. MethodsLatex was poured into the blood vessels of 8 cadavers, then perforator vessel of posterolateral upper calf was dissected, and the popliteal artery cutaneous branch flap was designed with a pedicle of 2.5 cm in length; the lateral tarsal artery of the foot was dissected, could be freed to 6 cm in length; the diameter of these vessels was measured, and the number of the accompanying veins was counted. Between March 2010 and January 2013, 13 cases of foot and ankle wounds were repaired with popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein. The size of flaps ranged from 6.0 cm×4.0 cm to 7.5 cm×5.5 cm. There were 11 males and 2 females, aged from 41 to 65 years (mean, 47.3 years). The causes of injury included traffic accident in 8 cases, crushing in 4 cases, and twist by machine in 1 case. The size of wounds, ranged from 5.0 cm×3.5 cm to 7.0 cm×5.0 cm. The donor sites were sutured directly. ResultsAccording to anatomical observation, the popliteal artery cutaneous branch flap was designed by using the lateral popliteal artery perforator for shaft. The vessel of the pedicle perforator flaps from the popliteal artery cutaneous branch flap matched well with the lateral tarsal artery. Clinical results: vascular crisis occurred in 2 flaps, which survived after symptomatic treatment; the other flaps survived, with primary healing of wound and incision at donor site. The patients were all followed up 5-18 months (mean, 11 months). The flap had normal color and good elasticity. Second stage operation was performed to make the flap thinner in 3 female patients because of bulky flaps. The remaining patients had no obvious fat flap. According to American Orthopaedic Foot and Ankle Society (AOFAS) score for evaluation of the ankle function at 6 months after operation, the results were excellent in 7 cases, good in 5 cases, and fair in 1 case, with an excellent and good rate of 92.3%. ConclusionFree popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein for the repair of wound on the foot and ankle is simple and effective. The donor site is hidden.

聯體股前外側穿支皮瓣修復足踝部大面積軟組織缺損

目的總結應用聯體股前外側穿支皮瓣修復足踝部大面積軟組織缺損的方法與療效。方法2020年1月—2022年1月，應用聯體股前外側穿支皮瓣修復足踝部大面積軟組織缺損10例。男7例，女3例；年齡18～60歲，平均34歲。創面位于足部5例，踝關節及足部5例；均伴有骨、肌腱外露。皮膚缺損范圍為25 cm×7 cm～33 cm×13 cm。受傷至手術時間3～31 d，平均8 d。皮瓣切取范圍為26 cm×8 cm～34 cm×13 cm；蒂長7～16 cm，平均9.5 cm。通過與旋股外側動脈降支遠端或分支行內增壓6例，與受區血管分支吻合行外增壓4例。供區直接縫合8例，植皮修復2例。 結果術后9例皮瓣完全成活，1例出現皮瓣近端部分淺層壞死，經換藥后愈合；供區創面均Ⅰ期愈合，植皮均成活。10例患者均獲隨訪，隨訪時間3～24個月，平均11個月。皮瓣顏色、質地良好，負重區無壓瘡。2例皮瓣局部稍臃腫，予以二期削薄；余8例皮瓣外形良好。所有患者均恢復正常行走功能。術后3個月足踝部美國矯形足踝協會（AOFAS）評分達優6例、良3例、可1例，優良率90%。 結論聯體股前外側穿支皮瓣可切取較大面積和長度，且供區損傷小，是修復足踝部大面積軟組織缺損的理想方法之一。

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

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%. ConclusionThe 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.

腓腸神經營養血管蒂逆行島狀皮瓣修復足踝部深度燒傷

腓腸神經營養血管逆行島狀皮瓣修復足踝部大面積軟組織缺損

目的 總結采用腓腸神經營養血管逆行島狀皮瓣修復足、踝、脛前區大面積皮膚軟組織缺損的臨床效果。 方法 2004 年6 月－ 2008 年12 月，收治12 例足、踝及脛前區大面積皮膚軟組織缺損患者。男8 例，女4 例；年齡21 ～ 63 歲，平均44.8 歲。交通傷9 例，慢性潰瘍、脛前區術后瘢痕、足背皮膚撕脫傷術后感染壞死創面各1 例。缺損部位：足背6 例，足跟、踝部、脛前區各2 例。軟組織缺損范圍6 cm × 4 cm ～ 16 cm × 9 cm。病程3 d ～ 18 個月。采用大小為8 cm × 6 cm ～ 18 cm × 10 cm 的腓腸神經營養血管逆行島狀皮瓣修復缺損，將小隱靜脈近端與創面周圍的回流靜脈吻合，腓腸神經近端與皮瓣受區供體神經端側縫合。供區植皮修復。 結果 術后皮瓣均順利成活，創面Ⅰ期愈合。供區2 例植皮部分壞死，經換藥后成活；其余植皮均順利成活，切口Ⅰ期愈合。12 例均獲隨訪，隨訪時間6 ～ 14 個月，平均9 個月。術后16 周根據英國醫學研究會標準進行感覺功能評定，其中S2 3 例，S2+ 5 例，S3 4 例。其中9 例皮瓣兩點辨別覺10 ～ 16 mm，平均14 mm。皮瓣色澤、質地、彈性良好，行走后無水皰及皮膚破潰損傷等。 結論 腓腸神經營養血管逆行島狀皮瓣修復足、踝及脛前區大面積皮膚軟組織缺損時，將小隱靜脈近端與受區回流靜脈吻合，腓腸神經近端與皮瓣受區供體神經端側縫合，利于皮瓣成活及感覺恢復，修復效果良好。

逆行隱神經皮瓣交腿移位修復難治足踝部創面

目的 總結采用逆行隱神經皮瓣交腿移位修復難治足踝部創面的方法及療效。 方法 2005 年9 月－2010 年11 月，采用逆行隱神經皮瓣交腿移位修復9 例難治足踝部創面。男8 例，女1 例；年齡17 ～ 47 歲，平均34.5 歲。交通事故傷5 例，重物壓砸傷3 例；傷后至入院時間為2 h ～ 6 個月。脈管炎1 例，病程18 個月。缺損部位：踝部4 例，足跟部3 例，前足2 例。缺損范圍為6 cm × 5 cm ～ 17 cm × 11 cm。術中皮瓣切取范圍為8 cm × 6 cm ～ 16 cm × 10 cm，術后3 ～ 5 周行皮瓣斷蒂。供區游離植皮修復。 結果 1 例感染創面術后4 d 發生局限感染，經換藥處理后愈合，皮瓣成活；其余交腿皮瓣及供區植皮均順利成活，創面Ⅰ期愈合。患者均獲隨訪，隨訪時間6 ～ 34 個月，平均16 個月。皮瓣質地優良，無潰瘍發生。術后22 個月皮瓣兩點辨別覺為8 ～ 10 mm，均恢復保護性感覺。足踝均能負重行走，踝關節活動范圍：背伸8 ～ 20°，跖屈10 ～ 35°。供區術后足背內側感覺支配區麻木感范圍隨時間延長縮小。 結論 逆行隱神經皮瓣切取簡便，厚薄適度，不損傷知名血管，術后可恢復皮瓣感覺，有效防止皮瓣再破潰，是修復足踝部創面的較好方法之 一。

Abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle

ObjectiveTo investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle.MethodsBetween June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly.ResultsDuring the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months.ConclusionThe abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.

REPAIR OF ANKLE SKIN AND SOFT TISSUE DEFECT WITH FREE SUPERFICIAL ILIAC CIRCUMFLEX ARTERY PERFORATOR FLAP

ObjectiveTo investigate the effectiveness of free superficial iliac circumflex artery perforator flap for repair of foot skin and soft tissue defect. MethodsBetween January 2010 and December 2015, 16 patients with ankle skin and soft tissue defect were treated. There were 13 males and 3 females with an average age of 32 years (range, 5-56 years). The causes included traffic accident injury in 8 cases, machinery injury in 3 cases, falling injury in 3 cases, and electrically injury in 2 cases. The time from injury to hospital was 1 to 6 hours (mean, 3.5 hours). The wound sites included foot dorsum skin defect in 6 cases, ankle skin defect in 5 cases, the back foot and ankle skin defect in 5 cases. The skin defect size ranged 5 cm×4 cm to 16 cm×7 cm. All patients had tendon exposure, and 8 patients had fracture. An emergency repair was performed in 6 cases, and selective surgery in 10 cases. The free iliac circumflex artery perforators flap was used to repair defect; the flap size was 6 cm×5 cm to 17 cm×8 cm, and the flap thickness was 0.4 to 1.1 cm (mean, 0.8 cm). ResultsThe flaps survived in the other 15 patients with primary healing of wounds except 1 patient because the iliac circumflex artery was too small to provide good blood supply, who underwent repair with local skin flap. Incision at donor site healed by first intention. The 15 cases were followed up 6-24 months (mean, 13 months). The appearance of the foot was satisfactory, and the flap had good texture without bulky flaps. ConclusionFree iliac circumflex artery perforators flap is one of ideal flaps in repair of skin defect of the foot and ankle because of hidden donor site, reliable blood supply, less injury to donor site, and full use of the flap.