Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Xi , XU Yongqing , SHI Yan , LIU Wuhua , FANG Xiang ,  HE Xiaoqing

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; perforator flap; lower limb; foot and ankle defect; children

DOI：

10.7507/1002-1892.202110041

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=−11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. Conclusion The perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.

Citation： YANG Xi, XU Yongqing, SHI Yan, LIU Wuhua, FANG Xiang, HE Xiaoqing. Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 329-334. doi: 10.7507/1002-1892.202110041 Copy

1.	Hifny MA, Tohamy AMA, Rabie O, et al. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. Ann Chir Plast Esthet, 2020, 65(1): 54-60.
2.	Onishi T, Shimizu T, Omokawa S, et al. Anatomical study of the popliteal artery perforator-based propeller flap and its clinical application. Plast Reconstr Surg, 2018, 142(2): 548-551.
3.	刘建, 黄凯, 沈立峰, 等. 腓动脉穿支蒂螺旋桨皮瓣修复足踝部软组织缺损. 中国骨伤. 2016, 29(12): 1088-1091.
4.	Özalp B, Aydınol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
5.	董云飞, 陶忠生, 吴清华, 等. 不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露. 临床骨科杂志, 2021, 24(1): 64-67.
6.	朱跃良, 殷作明, 范新宇, 等. 小腿受区血管缺乏时重建梯的研究. 中华显微外科杂志, 2017, 40(4): 328-332.
7.	甘干达, 扈克治, 唐继全, 等. 应用4种皮瓣修复小儿足跟部软组织缺损的临床效果. 创伤外科杂志, 2012, 14(3): 202-205.
8.	刘毅. 重视供区的美容修复. 中华烧伤杂志, 2020, 36(2): 81-84.
9.	唐举玉, 汪华侨, Hallock GG, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
10.	Abdelmegeed AG, Abulezz TA, Abo-Saeda MA, et al. Perforator-based pedicled cross-leg flaps in pediatric patients: A new idea to increase flap reach. Ann Plast Surg, 2021, 86(5): 568-572.
11.	王军, 印飞, 邹成达, 等. 不携带一级源血管的游离股前外侧穿支皮瓣修复儿童足跟部轮辐伤. 中华手外科杂志, 2020, 36(4): 244-246.
12.	古欣庆, 周洋, 朱红亮, 等. 削薄股前外侧皮瓣在儿童足踝部软组织缺损中的应用. 实用手外科杂志, 2021, 35(2): 173-176.
13.	徐永清, 何晓清, 朱跃良, 等. 股前外侧皮瓣在儿童四肢创面修复中的应用. 中华创伤杂志, 2018, 34(10): 875-880.
14.	曹文亮, 田峰, 田立杰. 腓动脉踝上穿支皮瓣修复儿童足踝部皮肤软组织缺损八例. 中华显微外科杂志, 2018, 41(4): 380-383.
15.	邓葵, 黄跟东, 陈明, 等. 腓动脉穿支皮瓣修复儿童足跟部严重轮辐伤. 中华显微外科杂志, 2018, 41(2): 145-147.
16.	唐举玉, 俞芳, 吴攀峰, 等. 胫后动脉穿支螺旋桨皮瓣修复儿童足跟部轮辐伤. 中华整形外科杂志, 2018, 34(8): 636-639.
17.	何晓清, 朱跃良, 徐永清, 等. 儿童足后跟Ⅲ级轮辐伤后跟腱重建中带蒂皮瓣选择. 中华创伤杂志, 2016, 32(5): 434-439.
18.	徐永清, 柴益民, 张世民, 等. 穿支螺旋桨皮瓣专家共识. 中华显微外科杂志, 2019, 42(5): 417-422.
19.	Kang JS, Choi HJ, Tak MS. Reconstruction of heel with propeller flap in postfasciotomy and popliteal artery revascularization state. Int J Low Extrem Wounds, 2016, 15(2): 132-135.
20.	Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plast Reconstr Surg, 2016, 137(1): 314-331.
21.	崔轶, 李国栋, 杨曦, 等. CTA联合手持彩色多普勒超声设计小腿穿支螺旋桨皮瓣的临床应用. 中华显微外科杂志, 2019, 42(3): 232-236.
22.	赵万秋, 徐永清, 何晓清, 等. 数字化技术在腓动脉穿支蒂螺旋桨皮瓣修复足跟部创面中的临床应用. 中国修复重建外科杂志, 2020, 34(3): 367-372.
23.	Cajozzo M, Jiga LP, Jandali Z, et al. Complications and solutions in propeller flap surgery. Semin Plast Surg, 2020, 34(3): 210-220.
24.	Wang P, Lin F, Ma Y, et al. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskelet Disord, 2021, 22(1): 643. doi: 10.1186/s12891-021-04522-z.
25.	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.
26.	Zang M, Zhu S, Chen B, et al. Perforator propeller flap “relay” for distal lower extremity soft tissue reconstruction. J Foot Ankle Surg, 2020, 59(5): 1128-1132.
27.	王伟, 李俊明, 代鹏威, 等. 胫前动脉穿支螺旋桨皮瓣接力腓动脉终末前穿支螺旋桨皮瓣修复足踝部创面. 中国修复重建外科杂志, 2020, 34(1): 87-91.
28.	Zhong W, Lu S, Wang C, et al. Single perforator greater saphenous neuro-veno-fasciocutaneous propeller flaps for lower extremity reconstructions. ANZ J Surg, 2017, 87(7-8): E40-E45.
29.	许育健, 何晓清, 徐永清, 等. 基于下肢CT血管成像的腘动脉分支变异的解剖学研究. 中华解剖与临床杂志, 2020, 25(5): 472-477.

1. Hifny MA, Tohamy AMA, Rabie O, et al. Propeller perforator flaps for coverage of soft tissue defects in the middle and distal lower extremities. Ann Chir Plast Esthet, 2020, 65(1): 54-60.
2. Onishi T, Shimizu T, Omokawa S, et al. Anatomical study of the popliteal artery perforator-based propeller flap and its clinical application. Plast Reconstr Surg, 2018, 142(2): 548-551.
3. 刘建, 黄凯, 沈立峰, 等. 腓动脉穿支蒂螺旋桨皮瓣修复足踝部软组织缺损. 中国骨伤. 2016, 29(12): 1088-1091.
4. Özalp B, Aydınol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
5. 董云飞, 陶忠生, 吴清华, 等. 不同方法修复儿童足跟轮辐伤皮肤缺损伴跟腱外露. 临床骨科杂志, 2021, 24(1): 64-67.
6. 朱跃良, 殷作明, 范新宇, 等. 小腿受区血管缺乏时重建梯的研究. 中华显微外科杂志, 2017, 40(4): 328-332.
7. 甘干达, 扈克治, 唐继全, 等. 应用4种皮瓣修复小儿足跟部软组织缺损的临床效果. 创伤外科杂志, 2012, 14(3): 202-205.
8. 刘毅. 重视供区的美容修复. 中华烧伤杂志, 2020, 36(2): 81-84.
9. 唐举玉, 汪华侨, Hallock GG, 等. 关注皮瓣供区问题——减少皮瓣供区损害专家共识. 中华显微外科杂志, 2018, 41(1): 3-5.
10. Abdelmegeed AG, Abulezz TA, Abo-Saeda MA, et al. Perforator-based pedicled cross-leg flaps in pediatric patients: A new idea to increase flap reach. Ann Plast Surg, 2021, 86(5): 568-572.
11. 王军, 印飞, 邹成达, 等. 不携带一级源血管的游离股前外侧穿支皮瓣修复儿童足跟部轮辐伤. 中华手外科杂志, 2020, 36(4): 244-246.
12. 古欣庆, 周洋, 朱红亮, 等. 削薄股前外侧皮瓣在儿童足踝部软组织缺损中的应用. 实用手外科杂志, 2021, 35(2): 173-176.
13. 徐永清, 何晓清, 朱跃良, 等. 股前外侧皮瓣在儿童四肢创面修复中的应用. 中华创伤杂志, 2018, 34(10): 875-880.
14. 曹文亮, 田峰, 田立杰. 腓动脉踝上穿支皮瓣修复儿童足踝部皮肤软组织缺损八例. 中华显微外科杂志, 2018, 41(4): 380-383.
15. 邓葵, 黄跟东, 陈明, 等. 腓动脉穿支皮瓣修复儿童足跟部严重轮辐伤. 中华显微外科杂志, 2018, 41(2): 145-147.
16. 唐举玉, 俞芳, 吴攀峰, 等. 胫后动脉穿支螺旋桨皮瓣修复儿童足跟部轮辐伤. 中华整形外科杂志, 2018, 34(8): 636-639.
17. 何晓清, 朱跃良, 徐永清, 等. 儿童足后跟Ⅲ级轮辐伤后跟腱重建中带蒂皮瓣选择. 中华创伤杂志, 2016, 32(5): 434-439.
18. 徐永清, 柴益民, 张世民, 等. 穿支螺旋桨皮瓣专家共识. 中华显微外科杂志, 2019, 42(5): 417-422.
19. Kang JS, Choi HJ, Tak MS. Reconstruction of heel with propeller flap in postfasciotomy and popliteal artery revascularization state. Int J Low Extrem Wounds, 2016, 15(2): 132-135.
20. Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: Identification of risk factors for complications. Plast Reconstr Surg, 2016, 137(1): 314-331.
21. 崔轶, 李国栋, 杨曦, 等. CTA联合手持彩色多普勒超声设计小腿穿支螺旋桨皮瓣的临床应用. 中华显微外科杂志, 2019, 42(3): 232-236.
22. 赵万秋, 徐永清, 何晓清, 等. 数字化技术在腓动脉穿支蒂螺旋桨皮瓣修复足跟部创面中的临床应用. 中国修复重建外科杂志, 2020, 34(3): 367-372.
23. Cajozzo M, Jiga LP, Jandali Z, et al. Complications and solutions in propeller flap surgery. Semin Plast Surg, 2020, 34(3): 210-220.
24. Wang P, Lin F, Ma Y, et al. Predictors of the surgical outcome of propeller perforator flap reconstruction, focusing on the effective safe distance between the perforator and the wound edge. BMC Musculoskelet Disord, 2021, 22(1): 643. doi: 10.1186/s12891-021-04522-z.
25. 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.
26. Zang M, Zhu S, Chen B, et al. Perforator propeller flap “relay” for distal lower extremity soft tissue reconstruction. J Foot Ankle Surg, 2020, 59(5): 1128-1132.
27. 王伟, 李俊明, 代鹏威, 等. 胫前动脉穿支螺旋桨皮瓣接力腓动脉终末前穿支螺旋桨皮瓣修复足踝部创面. 中国修复重建外科杂志, 2020, 34(1): 87-91.
28. Zhong W, Lu S, Wang C, et al. Single perforator greater saphenous neuro-veno-fasciocutaneous propeller flaps for lower extremity reconstructions. ANZ J Surg, 2017, 87(7-8): E40-E45.
29. 许育健, 何晓清, 徐永清, 等. 基于下肢CT血管成像的腘动脉分支变异的解剖学研究. 中华解剖与临床杂志, 2020, 25(5): 472-477.

Chinese Journal of Reparative and Reconstructive Surgery

Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content