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.	黄铿, 舒申友, 谢扬, 等. 胫后动脉穿支皮瓣修复足踝部组织缺损 12例. 中华显微外科杂志, 2014, 37(4):387-388.
2.	张功林, 陈克明, 赵来绪, 等. 胫后动脉穿支皮瓣带神经修复小儿足跟软组织缺损. 中华小儿外科杂志, 2012, 33(2):122-125.
3.	顾加祥, 潘俊博, 刘宏君, 等. 游离股前外侧动脉穿支皮瓣及腓动脉穿支皮瓣在足踝部创面中的应用. 中国修复重建外科杂志, 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.	张发惠, 郑和平, 宋一平, 等. 内踝区动脉网的显微解剖与隐神经营养血管远端蒂皮瓣的设计. 中国临床解剖学杂志, 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.	赵民, 李然, 李大村, 等. 足踝部皮肤软组织缺损的修复. 中国修复重建外科杂志, 2012, 26(2):255-256.
9.	张天华, 魏在荣. 胫后动脉穿支皮瓣的解剖与临床研究进展. 中国临床解剖学杂志, 2014, 32(2):231-233.
10.	卿黎明, 胡懿郃, 唐举玉, 等. 基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究. 中国修复重建外科杂志, 2014, 28(6):697-700.
11.	张磊, 畅坚, 吴云, 等. 对比增强MR血管成像诊断糖尿病下肢动脉闭塞症膝以下动脉狭窄的价值. 中华放射学杂志, 2014, 48(8): 664-669.
12.	王强, 牛玉军. CTA与DSA评价烟雾病血管狭窄程度的对比研究. 中国临床医学影像杂志, 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.	欧阳海洋, 牟勇, 吴伟炽, 等. 足内侧穿支皮瓣设计的解剖基础. 中国临床解剖学杂志, 2014, 32(2):141-144.
17.	牛国庆, 黄东, 吴伟炽, 等. 腓动脉双穿支皮瓣设计的解剖学分析与临床应用. 中国临床解剖学杂志, 2014, 32(1):1-4.
18.	吴必华, 魏在荣, 唐修俊, 等. 胫后动脉穿支蒂混合供血皮瓣修复儿童小腿创面. 中华小儿外科杂志, 2013, 34(5):349-352.

1. 黄铿, 舒申友, 谢扬, 等. 胫后动脉穿支皮瓣修复足踝部组织缺损 12例. 中华显微外科杂志, 2014, 37(4):387-388.
2. 张功林, 陈克明, 赵来绪, 等. 胫后动脉穿支皮瓣带神经修复小儿足跟软组织缺损. 中华小儿外科杂志, 2012, 33(2):122-125.
3. 顾加祥, 潘俊博, 刘宏君, 等. 游离股前外侧动脉穿支皮瓣及腓动脉穿支皮瓣在足踝部创面中的应用. 中国修复重建外科杂志, 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. 张发惠, 郑和平, 宋一平, 等. 内踝区动脉网的显微解剖与隐神经营养血管远端蒂皮瓣的设计. 中国临床解剖学杂志, 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. 赵民, 李然, 李大村, 等. 足踝部皮肤软组织缺损的修复. 中国修复重建外科杂志, 2012, 26(2):255-256.
9. 张天华, 魏在荣. 胫后动脉穿支皮瓣的解剖与临床研究进展. 中国临床解剖学杂志, 2014, 32(2):231-233.
10. 卿黎明, 胡懿郃, 唐举玉, 等. 基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究. 中国修复重建外科杂志, 2014, 28(6):697-700.
11. 张磊, 畅坚, 吴云, 等. 对比增强MR血管成像诊断糖尿病下肢动脉闭塞症膝以下动脉狭窄的价值. 中华放射学杂志, 2014, 48(8): 664-669.
12. 王强, 牛玉军. CTA与DSA评价烟雾病血管狭窄程度的对比研究. 中国临床医学影像杂志, 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. 欧阳海洋, 牟勇, 吴伟炽, 等. 足内侧穿支皮瓣设计的解剖基础. 中国临床解剖学杂志, 2014, 32(2):141-144.
17. 牛国庆, 黄东, 吴伟炽, 等. 腓动脉双穿支皮瓣设计的解剖学分析与临床应用. 中国临床解剖学杂志, 2014, 32(1):1-4.
18. 吴必华, 魏在荣, 唐修俊, 等. 胫后动脉穿支蒂混合供血皮瓣修复儿童小腿创面. 中华小儿外科杂志, 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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