Effectiveness of groin flap with external oblique aponeurosis for tendon and skin defects of dorsal foot_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lin , ZHOU Xin , HUANG Bo , LIU Anming , HUANG Yu ,  ZOU Yonggen

Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding author：

ZOU Yonggen, Email: yonggenzou1975@163.com

Keywords：

Groin flap; external oblique aponeurosis; dorsal foot; tendon defect; soft tissue defect; wound repair

DOI：

10.7507/1002-1892.202108132

Video：

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Objective To investigate the effectiveness of groin flap with external oblique aponeurosis in repair of tendon and skin defects of dorsal foot. Methods Between October 2016 and January 2020, 12 patients with compound tissue defects of the dorsal foot caused by trauma were treated. There were 9 males and 3 females, with a median age of 42 years (range, 32-65 years). The size of the skin defects ranged from 8 cm×5 cm to 12 cm×8 cm. All wounds were accompanied by extensor tendon injury, including 6 cases of extensor hallucis longus tendon defect, 5 cases of extensor digitalis longus tendon defect, and 3 cases of extensor digitalis longus tendon and extensor digitorum brevis defects. The interval between injury and admission was 1-6 hours (mean, 3 hours). After admission, the wounds were thoroughly debrided, and the groin flap with external oblique aponeurosis was used to repair the skin and tendon defects in the second stage. The size of skin flap ranged from 10 cm×6 cm to 13 cm×9 cm, and the size of the external oblique aponeurosis ranged from 5.5 cm×3.0 cm to 8.0 cm×5.0 cm. The wounds at donor sties were sutured directly. Results All flaps survived completely without significant complications. All incisions of the recipient and donor sites healed by first intention. All patients were followed up 16-24 months (mean, 18 months). The flaps were satisfactory in appearance and soft in texture. At last follow-up, 9 cases were excellent and 3 cases were good according to the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal joint scale criteria. The toe function was satisfactory. The line scar was left without hernia or other morbidity on the donor site. Conclusion The groin flap with the external oblique aponeurosis can repair the tendon and skin defects of the dorsal foot, with concealed donor site, easy dissection and adjustable thinness, as well as the enough tough aponeurosis.

Citation： TANG Lin, ZHOU Xin, HUANG Bo, LIU Anming, HUANG Yu, ZOU Yonggen. Effectiveness of groin flap with external oblique aponeurosis for tendon and skin defects of dorsal foot. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(2): 215-219. doi: 10.7507/1002-1892.202108132 Copy

1.	Jeng SF. Free composite groin flap and vascularized external oblique aponeurosis for traumatic avulsion injuries of the foot. J Trauma, 1993, 35(1): 71-74.
2.	Taylor GI, Townsend P. Composite free flap and tendon transfer: an anatomical study and a clinical technique. Br J Plast Surg, 1979, 32(3): 170-183.
3.	Berner JE, Nikkhah D, Zhao J, et al. The versatility of the superficial circumflex iliac artery perforator flap: A single surgeon’s 16-year experience for limb reconstruction and a systematic review. J Reconstr Microsurg, 2020, 36(2): 93-103.
4.	Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
5.	Rozen WM, Chubb D, Grinsell D, et al. The variability of the superficial inferior epigastric artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery, 2010, 30(5): 386-391.
6.	Iida T. Superficial circumflex iliac perforator (SCIP) flap: variations of the SCIP flap and their clinical applications. J Reconstr Microsurg, 2014, 30(7): 505-508.
7.	Ogino A, Onishi K, Nakamichi M. Primary reconstruction after maxillectomy defects using ultra flex mesh plate and rectus abdominis myocutaneous free flap including aponeurosis of external abdominal oblique muscle. J Craniofac Surg, 2019, 30(1): 211-213.
8.	Marshall DR, Anstee EJ, Stapleton MJ. Soft tissue reconstruction of the breast using an external oblique myocutaneous abdominal flap. Br J Plast Surg, 1982, 35(4): 443-451.
9.	Boyd JB, Taylor GI, Corlett R. The vascular territories of the superior epigastric and the deep inferior epigastric systems. Plast Reconstr Surg, 1984, 73(1): 1-16.
10.	Iida T, Yoshimatsu H, Hara H, et al. Reconstruction of large facial defects using a sensate superficial circumflex iliac perforator flap based on the lateral cutaneous branches of the intercostal nerves. Ann Plast Surg, 2014, 72(3): 328-331.
11.	Fernandez Garrido M, Qiu SS, Vega Garcia C, et al. Chimeric superficial circumflex iliac perforator flap including external oblique fascia: A refinement of conventional harvesting. Plast Reconstr Surg Glob Open, 2016, 4(6): e766. doi: 10.1097/GOX.0000000000000757.
12.	Wei FC, Chen HC, Chuang CC, et al. Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region. Plast Reconstr Surg, 1988, 81(4): 579-589.
13.	Yamamoto T, Saito T, Ishiura R, et al. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg, 2016, 69(9): 1260-1265.
14.	刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损. 中国修复重建外科杂志, 2021, 35(7): 886-890.
15.	周鑫, 邹永根, 唐林, 等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损. 中国修复重建外科杂志, 2021, 35(11): 1467-1471.
16.	Fan C, Fede C, Gaudreault N, et al. Anatomical and functional relationships between external abdominal oblique muscle and posterior layer of thoracolumbar fascia. Clin Anat, 2018, 31(7): 1092-1098.
17.	施权, 魏在荣. 旋髂浅动脉穿支皮瓣的应用进展. 中华显微外科杂志, 2018, 31(7): 1092-1098.
18.	吴学仁, 魏盼杰, 赵耀华, 等. 髂腹股沟复合组织瓣修复手足部皮肤软组织缺损的效果. 中华烧伤杂志, 2020, 36(8): 722-725.

1. Jeng SF. Free composite groin flap and vascularized external oblique aponeurosis for traumatic avulsion injuries of the foot. J Trauma, 1993, 35(1): 71-74.
2. Taylor GI, Townsend P. Composite free flap and tendon transfer: an anatomical study and a clinical technique. Br J Plast Surg, 1979, 32(3): 170-183.
3. Berner JE, Nikkhah D, Zhao J, et al. The versatility of the superficial circumflex iliac artery perforator flap: A single surgeon’s 16-year experience for limb reconstruction and a systematic review. J Reconstr Microsurg, 2020, 36(2): 93-103.
4. Rozen WM, Ashton MW, Taylor GI. Reviewing the vascular supply of the anterior abdominal wall: redefining anatomy for increasingly refined surgery. Clin Anat, 2008, 21(2): 89-98.
5. Rozen WM, Chubb D, Grinsell D, et al. The variability of the superficial inferior epigastric artery (SIEA) and its angiosome: A clinical anatomical study. Microsurgery, 2010, 30(5): 386-391.
6. Iida T. Superficial circumflex iliac perforator (SCIP) flap: variations of the SCIP flap and their clinical applications. J Reconstr Microsurg, 2014, 30(7): 505-508.
7. Ogino A, Onishi K, Nakamichi M. Primary reconstruction after maxillectomy defects using ultra flex mesh plate and rectus abdominis myocutaneous free flap including aponeurosis of external abdominal oblique muscle. J Craniofac Surg, 2019, 30(1): 211-213.
8. Marshall DR, Anstee EJ, Stapleton MJ. Soft tissue reconstruction of the breast using an external oblique myocutaneous abdominal flap. Br J Plast Surg, 1982, 35(4): 443-451.
9. Boyd JB, Taylor GI, Corlett R. The vascular territories of the superior epigastric and the deep inferior epigastric systems. Plast Reconstr Surg, 1984, 73(1): 1-16.
10. Iida T, Yoshimatsu H, Hara H, et al. Reconstruction of large facial defects using a sensate superficial circumflex iliac perforator flap based on the lateral cutaneous branches of the intercostal nerves. Ann Plast Surg, 2014, 72(3): 328-331.
11. Fernandez Garrido M, Qiu SS, Vega Garcia C, et al. Chimeric superficial circumflex iliac perforator flap including external oblique fascia: A refinement of conventional harvesting. Plast Reconstr Surg Glob Open, 2016, 4(6): e766. doi: 10.1097/GOX.0000000000000757.
12. Wei FC, Chen HC, Chuang CC, et al. Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region. Plast Reconstr Surg, 1988, 81(4): 579-589.
13. Yamamoto T, Saito T, Ishiura R, et al. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: A chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg, 2016, 69(9): 1260-1265.
14. 刘安铭, 周鑫, 欧昌良, 等. 携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损. 中国修复重建外科杂志, 2021, 35(7): 886-890.
15. 周鑫, 邹永根, 唐林, 等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损. 中国修复重建外科杂志, 2021, 35(11): 1467-1471.
16. Fan C, Fede C, Gaudreault N, et al. Anatomical and functional relationships between external abdominal oblique muscle and posterior layer of thoracolumbar fascia. Clin Anat, 2018, 31(7): 1092-1098.
17. 施权, 魏在荣. 旋髂浅动脉穿支皮瓣的应用进展. 中华显微外科杂志, 2018, 31(7): 1092-1098.
18. 吴学仁, 魏盼杰, 赵耀华, 等. 髂腹股沟复合组织瓣修复手足部皮肤软组织缺损的效果. 中华烧伤杂志, 2020, 36(8): 722-725.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of groin flap with external oblique aponeurosis for tendon and skin defects of dorsal foot

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