OBJECTIVE: To investigate the clinical effect of pre-fabricated free skin flap in reconstruction and repair of skin defect of foot in weight-bearing area. METHODS: Eight cases of skin defect of foot in weight-bearing area, due to trauma, were repaired by such an approach; free skin flap was designed and pre-fabricated at the contralateral plantar center, and 3 weeks later the free skin flap, with sensory nerve was transplanted to the site of skin defect, fixed by stitches through drilled holes in the calcaneous bone. All of 8 cases were followed up for 15 to 23 months before clinical evaluation. RESULTS: The wound healed well with no ulcer or deformity. According to American AOFAS scoring standard, it was more than 80 in 5 cases, more than 75 in 2 cases and 70 in one case. CONCLUSION: The pre-fabricated free skin flap from the contralateral plantar center is a good option to reconstruct and repair the skin defect of foot in weight-bearing area, with low ulcer occurrence and good contour.
ObjectiveTo investigate the anatomic features of the perforating branch flap of the medial vastus muscle, so as to provide a new perforating branch flap for repairing the soft tissue defect. MethodsSix fresh donated lower limb specimens underwent an intra-arterial injection of a lead oxide and lactoprene preparation. The integument of the thigh was dissected to observe the origin, course, size, and location of the perforating branch of the medial vastus muscle by angiography and photography. Based on the anatomic study, the free perforating branch flaps of the medial vastus muscle (14 cm × 6 cm to 20 cm × 5 cm) were used to repair skin and soft tissue defects (8 cm × 6 cm to 12 cm × 8 cm) of the feet in 4 patients between June 2009 and August 2011. ResultsThe artery of the medial vastus was sent out constantly from the femoral artery, and then descended in the vastus muscle to lateral patella where it anastomosed with the terminal branches of lateral femoral circumflex artery to form prepatellar vascular network. The artery of the medial vastus sent out 3-5 musculocutaneous perforating branches into the deep fascia and then extended superficially to the overlying skin. Four flaps survived after surgery; wounds at the donor site and recipient site healed by first intention. After follow-up of 6-12 months, the flaps had good appearance and texture. All ankles had normal movement range of plantarflexion and dorsiflexion. ConclusionThe free perforating branch flaps of the medial vastus muscle can be harvested easily, and have the advantage of good texture and abundant donor site.