Reconstruction of the donor area of distally based sural flap with relaying lateral gastrocnemius artery perforator propeller flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Dajiang ¹ ,  LI Zan ¹ , ZHOU Xiao ¹ , CHI Zhenglin ² ,  ZHOU Xin ³

1. Department of Oncology Plastic Surgery, Hunan Province Cancer Hospital, Changsha Hunan, 410008, P.R.China;
2. Department of Hand Surgery, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou Zhejiang, 325027, P.R.China;
3. Department of Hand Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646600, P.R.China;

Corresponding author：

LI Zan, Email: zzanli@163.com; ZHOU Xin, Email: johnsondan@163.com

Keywords：

Foot and ankle defect; sural flap; lateral gastrocnemius artery; relaying flap; wound repair

DOI：

10.7507/1002-1892.201705126

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Objective To investigate the clinical application of relaying lateral gastrocnemius artery perforator flap in reconstruction of the donor defect after distally sural flap transferring. Methods Between January 2014 and January 2016, 12 cases with foot and ankle defects were treated. There were 10 males and 2 females with an average age of 23.4 years (mean, 14-52 years). The injury was caused by motorcycle accident in 7 cases and traffic accident in 5 cases. The injury located at left limb in 7 cases and right limb in 5 cases. The size of soft tissue ranged from 10 cm×4 cm to 12 cm×6 cm. The disease duration was 2-84 hours (mean, 26.2 hours). The foot and ankle defects were reconstructed by distally sural flaps, then the flap donor sites were reconstructed with relaying lateral gastrocnemius artery perforator flap at the same stage. The size of distally sural flap ranged from 11 cm×5 cm to 13 cm×7 cm. The size of relaying flap ranged from 7 cm×4 cm to 10 cm×6 cm. Results All flaps survived uneventfully. All recipient sites and donor sites healed smoothly. No vascular crisis, wound dehiscence, or evident swelling occurred. All patients were followed up 6-14 months (mean, 12.4 months) with satisfied esthetic and functional results in recipient and donor sites. There were only linear scar on the donor sites. The color and contour was satisfying, the function of calf and foot were not affected. Conclusion The relaying lateral gastrocnemius artery perforator flap combined with distally sural flap is an idea choice to reconstruct foot and ankle defect, which can avoid donor site skin grafting, minimize donor site morbidity.

Citation： SONG Dajiang, LI Zan, ZHOU Xiao, CHI Zhenglin, ZHOU Xin. Reconstruction of the donor area of distally based sural flap with relaying lateral gastrocnemius artery perforator propeller flap. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1363-1366. doi: 10.7507/1002-1892.201705126 Copy

1.	Ducic I, Attinger CE. Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes. Plast Reconstr Surg, 2011, 128(1): 173-180.
2.	Xie S, Deng X, Chen Y, et al. Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap. J Plast Surg Hand Surg, 2016, 50(6): 367-374.
3.	Liu L, Zou L, Li Z, et al. The extended distally based sural neurocutaneous flap for foot and ankle reconstruction: a retrospective review of 10 years of experience. Ann Plast Surg, 2014, 72(6): 689-694.
4.	Chang SM, Li XH, Gu YD. Distally based perforator sural flaps for foot and ankle reconstruction. World J Orthop, 2015, 6(3): 322-330.
5.	Zheng H, Liu J, Dai X, et al. The Distally Based Sural Flap for the Reconstruction of Ankle and Foot Defects in Pediatric Patients. Ann Plast Surg, 2016, 77(1): 97-101.
6.	Lee JH, Chung DW. Reverse lateral supramalleolar adipofascial flap and skin grafting for one-stage soft tissue reconstruction of foot and ankle joint. Microsurgery, 2010, 30(6): 423-429.
7.	Boopalan PR, Nithyananth M, Jepegnanam TS. Lateral gastrocnemius flap cover for distal thigh soft tissue loss. J Trauma, 2010, 69(5): E38-41.
8.	Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg, 2001, 47(5): 517-522.
9.	Afifi AM, Mahboub TA, Losee JE, et al. The reverse sural flap: modifications to improve efficacy in foot and ankle reconstruction. Ann Plast Surg, 2008, 61(4): 430-436.
10.	Attinger CE, Evans KK, Bulan E, et al. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg, 2006, 117 (7 Suppl): 261S-293S.
11.	Taylor GI, Corlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg, 2011, 127(4): 1447-1459.
12.	Taylor GI, Palmer JH. Angiosome theory. Br J Plast Surg, 1992, 45(4): 327-328.
13.	Suami H, Taylor GI, Pan WR. Angiosome territories of the nerves of the lower limbs. Plast Reconstr Surg, 2003, 112(7): 1790-1798.
14.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.

1. Ducic I, Attinger CE. Foot and ankle reconstruction: pedicled muscle flaps versus free flaps and the role of diabetes. Plast Reconstr Surg, 2011, 128(1): 173-180.
2. Xie S, Deng X, Chen Y, et al. Reconstruction of foot and ankle defects with a superthin innervated anterolateral thigh perforator flap. J Plast Surg Hand Surg, 2016, 50(6): 367-374.
3. Liu L, Zou L, Li Z, et al. The extended distally based sural neurocutaneous flap for foot and ankle reconstruction: a retrospective review of 10 years of experience. Ann Plast Surg, 2014, 72(6): 689-694.
4. Chang SM, Li XH, Gu YD. Distally based perforator sural flaps for foot and ankle reconstruction. World J Orthop, 2015, 6(3): 322-330.
5. Zheng H, Liu J, Dai X, et al. The Distally Based Sural Flap for the Reconstruction of Ankle and Foot Defects in Pediatric Patients. Ann Plast Surg, 2016, 77(1): 97-101.
6. Lee JH, Chung DW. Reverse lateral supramalleolar adipofascial flap and skin grafting for one-stage soft tissue reconstruction of foot and ankle joint. Microsurgery, 2010, 30(6): 423-429.
7. Boopalan PR, Nithyananth M, Jepegnanam TS. Lateral gastrocnemius flap cover for distal thigh soft tissue loss. J Trauma, 2010, 69(5): E38-41.
8. Hallock GG. Anatomic basis of the gastrocnemius perforator-based flap. Ann Plast Surg, 2001, 47(5): 517-522.
9. Afifi AM, Mahboub TA, Losee JE, et al. The reverse sural flap: modifications to improve efficacy in foot and ankle reconstruction. Ann Plast Surg, 2008, 61(4): 430-436.
10. Attinger CE, Evans KK, Bulan E, et al. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg, 2006, 117 (7 Suppl): 261S-293S.
11. Taylor GI, Corlett RJ, Dhar SC, et al. The anatomical (angiosome) and clinical territories of cutaneous perforating arteries: development of the concept and designing safe flaps. Plast Reconstr Surg, 2011, 127(4): 1447-1459.
12. Taylor GI, Palmer JH. Angiosome theory. Br J Plast Surg, 1992, 45(4): 327-328.
13. Suami H, Taylor GI, Pan WR. Angiosome territories of the nerves of the lower limbs. Plast Reconstr Surg, 2003, 112(7): 1790-1798.
14. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory: vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5): 1529-1544.

Chinese Journal of Reparative and Reconstructive Surgery

Reconstruction of the donor area of distally based sural flap with relaying lateral gastrocnemius artery perforator propeller flap

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