Reconstruction of ankle and foot with combination of free perforator flaps and skin graft_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YIN Lu ,  GONG Ketong , YIN Zhonggang , ZHANG Bo , XU Jianhua

Department of Hand Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China;

Corresponding author：

GONG Ketong, Email: gongketong1961@163.com

Keywords：

Perforator flap; skin graft; ankle and foot; soft tissue defect; vacuum sealing drainage

DOI：

10.7507/1002-1892.201610122

Video：

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Objective To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Methods Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Results Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Conclusion Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

Citation： YIN Lu, GONG Ketong, YIN Zhonggang, ZHANG Bo, XU Jianhua. Reconstruction of ankle and foot with combination of free perforator flaps and skin graft. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 319-322. doi: 10.7507/1002-1892.201610122 Copy

1.	刘勇, 康彦忠, 李文龙, 等. 游离腓动脉穿支皮瓣修复手足软组织缺损. 中华创伤骨科杂志, 2015, 17(7): 579-583.
2.	陈雪松, 徐永清, 陈建民, 等. 主穿支皮神经营养血管皮瓣一期修复小腿及足踝部高能损伤创面. 中华整形外科杂志, 2013, 29(2): 81-86.
3.	蓝旭, 厉孟, 葛宝丰, 等. 高能量损伤致足跟软组织缺损的修复. 中华创伤杂志, 2015, 31(4): 338-341.
4.	毛海蛟, 史增元, 尹维刚, 等. 逆行足内侧隐神经营养血管皮瓣修复足前部皮肤缺损的解剖与临床应用. 中华整形外科杂志, 2015, 31(1): 25-29.
5.	张永明, 周玉新, 刘兴盛, 等. 前踝上皮瓣修复足背远端软组织缺损 10 例. 中华创伤杂志, 2014, 30(10): 1033-1034.
6.	朱跃良, 梅良斌, 吕乾, 等. 足踝软组织重建的皮瓣选择策略: 14 种皮瓣 226 例分析. 中华显微外科杂志, 2014, 37(3): 242-245.
7.	赵风景, 张兴群, 姚建民, 等. 游离胫后动脉穿支皮瓣修复手、足背皮肤缺损. 中华整形外科杂志, 2011, 27(6): 418-420.
8.	胡稷杰, 任高宏, 王钢, 等. 游离股前外侧穿支皮瓣或隐动脉穿支皮瓣修复足踝部软组织缺损. 中华显微外科杂志, 2012, 35(6): 453-456.
9.	高曙光, 唐举玉, 罗令, 等. 腹壁下动脉穿支皮瓣在小儿足踝部软组织缺损中的应用. 中华创伤杂志, 2009, 25(4): 294-297.
10.	程国良. 手部皮肤覆盖原则与趋向. 中华手外科杂志, 2006, 22(5): 257-258.
11.	Fleischmann W, Becker V, Bischoff M, et al. Vacuum sealing, technique, and results. Eur J Orthop Surg Traumatol, 1995, 5(1): 37-40.
12.	Baharestani M, Amjad I, Bookout K, et al. V.A.C.Therapy in the management of paediatric wounds: clinical review and experience. Int Wound J, 2009, 6 Suppl 1: 1-26.
13.	王相, 张威凯, 王海兵, 等. 负压封闭引流联合游离胫后动脉串联皮瓣修复前足脱套伤. 中华整形外科杂志, 2013, 29(4): 258-260.
14.	严立, 胡锐, 丁凡, 等. 负压封闭引流技术联合游离皮瓣移植治疗合并骨折的小腿及足踝部热压伤. 中华创伤骨折杂志, 2013, 15(4): 312-315.
15.	Chernichenko N, Ross DA, Shin J, et al. Arterial coupling for microvascular free tissue transfer. J Otolaryngol Head Neck Surg, 2008, 138(5): 614-618.

1. 刘勇, 康彦忠, 李文龙, 等. 游离腓动脉穿支皮瓣修复手足软组织缺损. 中华创伤骨科杂志, 2015, 17(7): 579-583.
2. 陈雪松, 徐永清, 陈建民, 等. 主穿支皮神经营养血管皮瓣一期修复小腿及足踝部高能损伤创面. 中华整形外科杂志, 2013, 29(2): 81-86.
3. 蓝旭, 厉孟, 葛宝丰, 等. 高能量损伤致足跟软组织缺损的修复. 中华创伤杂志, 2015, 31(4): 338-341.
4. 毛海蛟, 史增元, 尹维刚, 等. 逆行足内侧隐神经营养血管皮瓣修复足前部皮肤缺损的解剖与临床应用. 中华整形外科杂志, 2015, 31(1): 25-29.
5. 张永明, 周玉新, 刘兴盛, 等. 前踝上皮瓣修复足背远端软组织缺损 10 例. 中华创伤杂志, 2014, 30(10): 1033-1034.
6. 朱跃良, 梅良斌, 吕乾, 等. 足踝软组织重建的皮瓣选择策略: 14 种皮瓣 226 例分析. 中华显微外科杂志, 2014, 37(3): 242-245.
7. 赵风景, 张兴群, 姚建民, 等. 游离胫后动脉穿支皮瓣修复手、足背皮肤缺损. 中华整形外科杂志, 2011, 27(6): 418-420.
8. 胡稷杰, 任高宏, 王钢, 等. 游离股前外侧穿支皮瓣或隐动脉穿支皮瓣修复足踝部软组织缺损. 中华显微外科杂志, 2012, 35(6): 453-456.
9. 高曙光, 唐举玉, 罗令, 等. 腹壁下动脉穿支皮瓣在小儿足踝部软组织缺损中的应用. 中华创伤杂志, 2009, 25(4): 294-297.
10. 程国良. 手部皮肤覆盖原则与趋向. 中华手外科杂志, 2006, 22(5): 257-258.
11. Fleischmann W, Becker V, Bischoff M, et al. Vacuum sealing, technique, and results. Eur J Orthop Surg Traumatol, 1995, 5(1): 37-40.
12. Baharestani M, Amjad I, Bookout K, et al. V.A.C.Therapy in the management of paediatric wounds: clinical review and experience. Int Wound J, 2009, 6 Suppl 1: 1-26.
13. 王相, 张威凯, 王海兵, 等. 负压封闭引流联合游离胫后动脉串联皮瓣修复前足脱套伤. 中华整形外科杂志, 2013, 29(4): 258-260.
14. 严立, 胡锐, 丁凡, 等. 负压封闭引流技术联合游离皮瓣移植治疗合并骨折的小腿及足踝部热压伤. 中华创伤骨折杂志, 2013, 15(4): 312-315.
15. Chernichenko N, Ross DA, Shin J, et al. Arterial coupling for microvascular free tissue transfer. J Otolaryngol Head Neck Surg, 2008, 138(5): 614-618.

Chinese Journal of Reparative and Reconstructive Surgery

Reconstruction of ankle and foot with combination of free perforator flaps and skin graft

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