Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Wanqiu , XU Yongqing ,  HE Xiaoqing , LUO Haotian , XU Yujian

Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China;

Corresponding author：

HE Xiaoqing, Email: hxq00@foxmail.com

Keywords：

Propeller flap; peroneal artery perforator; digital technology; heel; wound repair

DOI：

10.7507/1002-1892.201908079

Video：

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Objective To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.Methods Between March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained.Results The origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements (P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.Conclusion The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.

Citation： ZHAO Wanqiu, XU Yongqing, HE Xiaoqing, LUO Haotian, XU Yujian. Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 367-372. doi: 10.7507/1002-1892.201908079 Copy

1.	Özalp B, Aydınol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
2.	Mendieta M, Cabrera R, Siu A, et al. Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects. Plast Reconstr Surg Glob Open, 2018, 6(5): e1759.
3.	Yu D, Hou Q, Liu A, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique. Surg Radiol Anat, 2016, 38(9): 1075-1081.
4.	张元智, 陆声, 温树正, 等. 数字化技术在隐动脉皮瓣血供的可视化及其临床初步应用. 中华创伤骨科杂志, 2013, 15(1): 32-35.
5.	Laungani AT, Van Alphen N, Christner JA, et al. Three-dimensional CT angiography assessment of the impact of the dermis and the subdermal plexus in DIEP flap perfusion. J Plast Reconstr Aesthet Surg, 2015, 68(4): 525-530.
6.	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.
7.	Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. J Plast Reconstr Surg, 2008, 122(2): 429-437.
8.	李国栋, 徐永清, 何晓清, 等. 数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用研究. 中国修复重建外科杂志, 2017, 31(5): 564-569.
9.	王顺吉, 章文博, 于尧, 等. 术前虚拟设计在股前外侧皮瓣修复口腔颌面部缺损中的应用. 北京大学学报 (医学版), 2019, 17(12): 1242-1247.
10.	唐举玉, 卿黎明, 贺继强, 等. 数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣设计的初步应用. 中华显微外科杂志, 2016, 13(2): 123-126.
11.	莫勇军, 谭海涛, 杨克勤, 等. 数字化技术辅助股前外侧皮瓣移植修复四肢软组织缺损 24 例. 中华显微外科杂志, 2015, 38(6): 592-595.
12.	段家章, 何晓清, 徐永清, 等. 数字化技术在股前外侧皮瓣修复手足创面中的应用. 中国修复重建外科杂志, 2015, 9(7): 807-811.
13.	Hupkens P, Schijns W, Van Abeelen M, et al. Lateral lower leg perforator flaps: an anatomical study to localize and classify lateral lower leg perforators. Microsurgery, 2015, (35): 140-147.
14.	Sur YJ, Morsy M, Mohan AT, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg, 2016, 137(5): 1615-1628.
15.	Punyavong P, Winaikosol K, Jenwitheesuk K, et al. An anatomical study of vascular supply of the distally based sural artery flap: a cadaveric study. J Med Assoc Thai, 2016, 99 Suppl 5: S182-S186.
16.	Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
17.	周洪翔, 陈亮, 李俊杰, 等. 改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用. 中国矫形外科杂志, 2017, 25(6): 517-520.
18.	Acartürk TO, Maldonado AA, Ereso A. Intraoral reconstruction with “thinned” peroneal artery perforator flaps: An alternative to classic donor areas in comorbid patients. Microsurgery, 2015, 35(5): 399-402.
19.	Dhua S, Manashree S, Tilak BG, et al. The clinical outcome of perforator based sural artery and propeller flaps in reconstruction of soft tissue of extremities. World J Plast Surg, 2019, 8(1): 3-11.
20.	Ono S, Hayashi H, Ohi H, et al. Imaging studies for preoperative planning of perforator flaps: an overview. Clin Plast Surg, 2017, 44(1): 21-30.
21.	陶友伦, 张世民, 陈文龙, 等. 穿支血管蒂螺旋桨皮瓣蒂部血管扭转的非线性有限元模拟研究. 中国临床解剖学杂志, 2014, 32(2): 201-205.
22.	张子阳, 张文夺, 魏再荣, 等. 数字减影血管造影在胫后动脉穿支皮瓣修复足踝部创面中的应用研究. 中国修复重建外科杂志, 2015, 29(9): 1109-1112.

1. Özalp B, Aydınol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
2. Mendieta M, Cabrera R, Siu A, et al. Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects. Plast Reconstr Surg Glob Open, 2018, 6(5): e1759.
3. Yu D, Hou Q, Liu A, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique. Surg Radiol Anat, 2016, 38(9): 1075-1081.
4. 张元智, 陆声, 温树正, 等. 数字化技术在隐动脉皮瓣血供的可视化及其临床初步应用. 中华创伤骨科杂志, 2013, 15(1): 32-35.
5. Laungani AT, Van Alphen N, Christner JA, et al. Three-dimensional CT angiography assessment of the impact of the dermis and the subdermal plexus in DIEP flap perfusion. J Plast Reconstr Aesthet Surg, 2015, 68(4): 525-530.
6. 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.
7. Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. J Plast Reconstr Surg, 2008, 122(2): 429-437.
8. 李国栋, 徐永清, 何晓清, 等. 数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用研究. 中国修复重建外科杂志, 2017, 31(5): 564-569.
9. 王顺吉, 章文博, 于尧, 等. 术前虚拟设计在股前外侧皮瓣修复口腔颌面部缺损中的应用. 北京大学学报 (医学版), 2019, 17(12): 1242-1247.
10. 唐举玉, 卿黎明, 贺继强, 等. 数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣设计的初步应用. 中华显微外科杂志, 2016, 13(2): 123-126.
11. 莫勇军, 谭海涛, 杨克勤, 等. 数字化技术辅助股前外侧皮瓣移植修复四肢软组织缺损 24 例. 中华显微外科杂志, 2015, 38(6): 592-595.
12. 段家章, 何晓清, 徐永清, 等. 数字化技术在股前外侧皮瓣修复手足创面中的应用. 中国修复重建外科杂志, 2015, 9(7): 807-811.
13. Hupkens P, Schijns W, Van Abeelen M, et al. Lateral lower leg perforator flaps: an anatomical study to localize and classify lateral lower leg perforators. Microsurgery, 2015, (35): 140-147.
14. Sur YJ, Morsy M, Mohan AT, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg, 2016, 137(5): 1615-1628.
15. Punyavong P, Winaikosol K, Jenwitheesuk K, et al. An anatomical study of vascular supply of the distally based sural artery flap: a cadaveric study. J Med Assoc Thai, 2016, 99 Suppl 5: S182-S186.
16. Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
17. 周洪翔, 陈亮, 李俊杰, 等. 改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用. 中国矫形外科杂志, 2017, 25(6): 517-520.
18. Acartürk TO, Maldonado AA, Ereso A. Intraoral reconstruction with “thinned” peroneal artery perforator flaps: An alternative to classic donor areas in comorbid patients. Microsurgery, 2015, 35(5): 399-402.
19. Dhua S, Manashree S, Tilak BG, et al. The clinical outcome of perforator based sural artery and propeller flaps in reconstruction of soft tissue of extremities. World J Plast Surg, 2019, 8(1): 3-11.
20. Ono S, Hayashi H, Ohi H, et al. Imaging studies for preoperative planning of perforator flaps: an overview. Clin Plast Surg, 2017, 44(1): 21-30.
21. 陶友伦, 张世民, 陈文龙, 等. 穿支血管蒂螺旋桨皮瓣蒂部血管扭转的非线性有限元模拟研究. 中国临床解剖学杂志, 2014, 32(2): 201-205.
22. 张子阳, 张文夺, 魏再荣, 等. 数字减影血管造影在胫后动脉穿支皮瓣修复足踝部创面中的应用研究. 中国修复重建外科杂志, 2015, 29(9): 1109-1112.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap

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