Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Changshun , HU Xiang , ZHENG Qianjin , DUAN Yong , LIU Siyi ,  TAO Shengxiang

Department of Trauma and Micro-orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;

Corresponding author：

TAO Shengxiang, Email: ZN-taoshengxiang@163.com

Keywords：

Posterior tibial artery; composite tissue flap; compound tissue defect; wound repair

DOI：

10.7507/1002-1892.201805093

Video：

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Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.

Citation： CHEN Changshun, HU Xiang, ZHENG Qianjin, DUAN Yong, LIU Siyi, TAO Shengxiang. Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 75-79. doi: 10.7507/1002-1892.201805093 Copy

1.	陶圣祥, 喻爱喜, 余国荣, 等. 腓肠神经营养血管肌皮瓣的解剖与临床应用. 中华整形外科杂志, 2008, 24(1): 16-19.
2.	唐举玉, 魏在荣, 张世民, 等. 穿支皮瓣的临床应用原则专家共识. 中国临床解剖学杂志, 2016, 34(1): 4-5.
3.	赵治伟, 刘文静, 查朱青, 等. 带胫骨隐神经复合组织皮瓣在小腿创伤性骨与皮肤缺损中的临床应用. 中国骨伤, 2017, 30(12): 1131-1134.
4.	任高宏, 任义军, 王钢, 等. 组合皮瓣修复小腿及足踝部大面积软组织缺损. 中华创伤骨科杂志, 2009, 11(11): 1042-1046.
5.	张文龙, 杜晓健, 李冀, 等. 胫后动脉穿支皮瓣. 中华解剖与临床杂志, 2017, 22(1): 87-88.
6.	Bista N, Shrestha KM, Bhattachan CL, et al. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities (distal 1/3 leg and foot). Nepal Med Coll J, 2013, 15(1): 56-61.
7.	柳昊, 叶澄宇, 余国荣, 等. 胫后血管蒂小腿内侧复合组织瓣的临床应用. 中国修复重建外科杂志, 2001, 15(3): 147-149.
8.	倪玉龙. 胫骨骨膜瓣的解剖学研究及临床应用. 唐山: 华北理工大学, 2016.
9.	Hou C, Chang S, Lin J, et al. Posterior tibial artery perforator flap//Surgical atlas of perforator flaps. Netherlands: Springer, 2015: 228-232.
10.	孙文晋, 陶圣祥, 余国荣, 等. 远端蒂腓浅神经营养血管肌皮瓣的解剖与临床应用. 中国临床解剖学杂志, 2012, 30(2): 166-168.
11.	赵风林, 李宗宝, 王鑫, 等. 超薄型胫后动脉穿支皮瓣的解剖学观察与临床应用. 中华整形外科杂志, 2013, 29(4): 261-265.
12.	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.
13.	Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg, 2008, 122(1): 161-170.
14.	Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg, 2005, 115(3): 793-801.
15.	柴益民, 邱勋永, 林崇正, 等. 胫后动脉穿支隐神经营养血管拟行皮瓣的临床应用. 中华显微外科杂志, 2004, 27(2): 99-100.
16.	陶圣祥, 喻爱喜, 郑晓晖, 等. 隐神经营养血管复合组织瓣的解剖学研究. 中华创伤骨科杂志, 2007, 9(3): 248-250.
17.	黄凯, 郭峭峰, 林炳远, 等. 胫后动脉穿支蒂螺旋桨皮瓣联合植骨一期治疗胫骨远端创伤性骨髓炎. 中华显微外科杂志, 2018, 40(1): 66-68.
18.	冯琼华, 张远金, 陶圣祥. 逆行隐神经营养血管肌-皮-骨复合组织瓣转位术的临床应用. 中国骨与关节损伤杂志, 2012, 27(9): 862-863.
19.	Sahijwani H, Warikoo V, Salunke AA, et al. Anterior tibial artery perforator plus flaps: Role in coverage of posttumor excision defects around the knee joint and upper leg. Asia Pac J Oncol Nurs, 2017, 4(4): 342-347.
20.	余黎, 余国荣, 陶圣祥, 等. 小腿软组织缺损合并节段性骨缺损的显微外科修复. 武汉大学学报 (医学版), 2012, 33(5): 705-707.

1. 陶圣祥, 喻爱喜, 余国荣, 等. 腓肠神经营养血管肌皮瓣的解剖与临床应用. 中华整形外科杂志, 2008, 24(1): 16-19.
2. 唐举玉, 魏在荣, 张世民, 等. 穿支皮瓣的临床应用原则专家共识. 中国临床解剖学杂志, 2016, 34(1): 4-5.
3. 赵治伟, 刘文静, 查朱青, 等. 带胫骨隐神经复合组织皮瓣在小腿创伤性骨与皮肤缺损中的临床应用. 中国骨伤, 2017, 30(12): 1131-1134.
4. 任高宏, 任义军, 王钢, 等. 组合皮瓣修复小腿及足踝部大面积软组织缺损. 中华创伤骨科杂志, 2009, 11(11): 1042-1046.
5. 张文龙, 杜晓健, 李冀, 等. 胫后动脉穿支皮瓣. 中华解剖与临床杂志, 2017, 22(1): 87-88.
6. Bista N, Shrestha KM, Bhattachan CL, et al. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities (distal 1/3 leg and foot). Nepal Med Coll J, 2013, 15(1): 56-61.
7. 柳昊, 叶澄宇, 余国荣, 等. 胫后血管蒂小腿内侧复合组织瓣的临床应用. 中国修复重建外科杂志, 2001, 15(3): 147-149.
8. 倪玉龙. 胫骨骨膜瓣的解剖学研究及临床应用. 唐山: 华北理工大学, 2016.
9. Hou C, Chang S, Lin J, et al. Posterior tibial artery perforator flap//Surgical atlas of perforator flaps. Netherlands: Springer, 2015: 228-232.
10. 孙文晋, 陶圣祥, 余国荣, 等. 远端蒂腓浅神经营养血管肌皮瓣的解剖与临床应用. 中国临床解剖学杂志, 2012, 30(2): 166-168.
11. 赵风林, 李宗宝, 王鑫, 等. 超薄型胫后动脉穿支皮瓣的解剖学观察与临床应用. 中华整形外科杂志, 2013, 29(4): 261-265.
12. 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.
13. Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg, 2008, 122(1): 161-170.
14. Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg, 2005, 115(3): 793-801.
15. 柴益民, 邱勋永, 林崇正, 等. 胫后动脉穿支隐神经营养血管拟行皮瓣的临床应用. 中华显微外科杂志, 2004, 27(2): 99-100.
16. 陶圣祥, 喻爱喜, 郑晓晖, 等. 隐神经营养血管复合组织瓣的解剖学研究. 中华创伤骨科杂志, 2007, 9(3): 248-250.
17. 黄凯, 郭峭峰, 林炳远, 等. 胫后动脉穿支蒂螺旋桨皮瓣联合植骨一期治疗胫骨远端创伤性骨髓炎. 中华显微外科杂志, 2018, 40(1): 66-68.
18. 冯琼华, 张远金, 陶圣祥. 逆行隐神经营养血管肌-皮-骨复合组织瓣转位术的临床应用. 中国骨与关节损伤杂志, 2012, 27(9): 862-863.
19. Sahijwani H, Warikoo V, Salunke AA, et al. Anterior tibial artery perforator plus flaps: Role in coverage of posttumor excision defects around the knee joint and upper leg. Asia Pac J Oncol Nurs, 2017, 4(4): 342-347.
20. 余黎, 余国荣, 陶圣祥, 等. 小腿软组织缺损合并节段性骨缺损的显微外科修复. 武汉大学学报 (医学版), 2012, 33(5): 705-707.

Chinese Journal of Reparative and Reconstructive Surgery

Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects

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