J Reconstr Microsurg 2011; 27(3): 145-150
DOI: 10.1055/s-0030-1268853
© Thieme Medical Publishers

Repair of Soft-Tissue Defect Close to the Distal Perforating Artery Using the Modified Distally Based Medial Fasciocutaneous Flap in the Distal Lower Leg

Xinzhong Shao1 , Yadong Yu1 , Xu Zhang2 , Xiaoqing Su1 , Yali Xu1 , Xiaoliang Yang1 , Li Lu1 , Li Wang1
  • 1Hand Surgery Department, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
  • 2Hand Surgery Department, The Second Hospital of Qinhuangdao, Changli, Qinhuangdao, Hebei, China
Further Information

Publication History

Publication Date:
23 November 2010 (online)

ABSTRACT

In this study, we modified distally based posterior tibial artery perforator flaps for repair of soft-tissue defects close to the distal perforating artery in the distal lower leg. The flap was designed along the axial network around the saphenous nerve. Flap transfer was performed in 45 cases. The size of the defects after debridement ranged from 4 × 3 cm to 20 × 8 cm (mean, 13 × 5.5 cm). Flap size ranged from 9 × 3 cm to 25 × 10 cm (mean, 16 × 7 cm). In this series, 41 flaps survived completely. Venous congestion was not observed. At a mean follow-up of 16.5 months, all flaps matched the recipient sites in color, texture, and thickness. Donor site morbidity was minimal. The modified distally based posterior tibial artery perforator flap is a reliable and useful option for coverage of the soft-tissue defect close to the distal perforating artery in the distal lower leg.

REFERENCES

  • 1 Pinsolle V, Reau A F, Pelissier P, Martin D, Baudet J. Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.  J Plast Reconstr Aesthet Surg. 2006;  59 912-917 discussion 918
  • 2 Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A. The vasculature and clinical application of the posterior tibial perforator-based flap.  Plast Reconstr Surg. 1992;  90 643-649
  • 3 Shalaby H A, Higazi M, Mandour S, el-Khalifa M A, Ayad H. Distally based medial island septocutaneous flap for repair of soft-tissue defects of the lower leg.  Br J Plast Surg. 1991;  44 175-178
  • 4 Jindarak S, Khobunsongserm S, Tansatit T. The anatomic basis of fasciocutaneous flap based on the posterior tibial vessels.  J Med Assoc Thai. 2001;  84 (Suppl 1) S283-S288
  • 5 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Perforator flaps in lower extremity reconstruction.  Handchir Mikrochir Plast Chir. 2002;  34 251-256
  • 6 Stadler F, Brenner E, Todoroff B, Papp C. Anatomical study of the perforating vessels of the lower leg.  Anat Rec. 1999;  255 374-379
  • 7 Hung L K, Lao J, Ho P C. Free posterior tibial perforator flap: anatomy and a report of 6 cases.  Microsurgery. 1996;  17 503-511
  • 8 Ozdemir R, Kocer U, Sahin B, Oruc M, Kilinc H, Tekdemir I. Examination of the skin perforators of the posterior tibial artery on the leg and the ankle region and their clinical use.  Plast Reconstr Surg. 2006;  117 1619-1630
  • 9 Carriquiry C, Aparecida Costa M, Vasconez L O. An anatomic study of the septocutaneous vessels of the leg.  Plast Reconstr Surg. 1985;  76 354-363
  • 10 Zhang X, Wang X, Wen S et al.. Posterior tibial artery-based multilobar combined flap free transfer for repair of complex soft tissue defects.  Microsurgery. 2008;  28 643-649
  • 11 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;  122 161-170
  • 12 Huang W C, Chen H C, Wei F C, Cheng M H, Schnur D P. Chimeric flap in clinical use.  Clin Plast Surg. 2003;  30 457-467
  • 13 Ozsoy M H, Tuccar E, Demiryurek D et al.. Minimally invasive plating of the distal tibia: do we really sacrifice saphenous vein and nerve? A cadaver study.  J Orthop Trauma. 2009;  23 132-138
  • 14 Masquelet A C, Romana M C, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg.  Plast Reconstr Surg. 1992;  89 1115-1121
  • 15 Nenad T, Reiner W, Michael S, Reinhard H, Hans H. Saphenous perforator flap for reconsturtive surgery in the lower leg and foot: a clinical study of 50 patients with posttraumatic osteomyelitis.  J Trauma. 2010;  68 1200-1207
  • 16 Heymans O, Verhelle N, Peters S, Nélissen X, Oelbrandt B. Use of the medial adipofascial flap of the leg for coverage of full-thickness burns exposing the tibial crest.  Burns. 2002;  28 674-678
  • 17 Naresh B, Parameswaran S. Reconstruction of lower leg defects using a medial island fasciocutaneous flap.  Med J Malaysia. 1998;  53 (Suppl A) 77-82
  • 18 Georgescu A V, Irina C, Ileana M. Cross-leg tibial posterior perforator flap.  Microsurgery. 2007;  27 379-383
  • 19 Mardini S, Salgado C J, Chen H C, Yazar S, Ozkan O, Sassu P. Posterior tibial artery flap in poliomyelitis patients with lower extremity paralysis.  Plast Reconstr Surg. 2006;  117 640-645
  • 20 Schierle C F, Rawlani V, Galiano R D, Kim J Y, Dumanian G A. Improving outcomes of the distally based hemisoleus flap: principles of angiosomes in flap design.  Plast Reconstr Surg. 2009;  123 1748-1754
  • 21 Rad A N, Singh N K, Rosson G D. Peroneal artery perforator-based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: case report and literature review.  Microsurgery. 2008;  28 663-670
  • 22 Hashmi P M. An experience with free scapular flap for reconstruction of lower extremity defects at Aga Khan University Hospital Karachi.  J Ayub Med Coll Abbottabad. 2004;  16 54-57
  • 23 Gonzalez M H, Tarandy D I, Troy D, Phillips D, Weinzweig N. Free tissue coverage of chronic traumatic wounds of the lower leg.  Plast Reconstr Surg. 2002;  109 592-600
  • 24 Calvert J W, Kohanzadeh S, Tynan M, Evans G R. Free flap reconstruction for infection of ankle fracture hardware: case report and review of the literature.  Surg Infect (Larchmt). 2006;  7 315-322
  • 25 Prantl L, Schreml S, Walter M et al.. Evaluation of microcirculation of free flaps of the lower leg by contrast harmonic imaging (CHI) with time intensity curve (TIC) analysis.  Clin Hemorheol Microcirc. 2008;  39 (1–4) 343-350
  • 26 Shimizu F, Kato A, Sato H, Taneda H. Sural perforator flap: assessment of the posterior calf region as donor site for a free fasciocutaneous flap.  Microsurgery. 2009;  29 253-258
  • 27 Garrett A, Ducic Y, Athre R S, Motley T, Carpenter B. Evaluation of fibula free flap donor site morbidity.  Am J Otolaryngol. 2006;  27 29-32
  • 28 Pinsolle V, Reau A F, Pelissier P, Martin D, Baudet J. Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.  J Plast Reconstr Aesthet Surg. 2006;  59 912-917 discussion 918
  • 29 Schaverien M V, Hamilton S A, Fairburn N, Rao P, Quaba A A. Lower limb reconstruction using the islanded posterior tibial artery perforator flap.  Plast Reconstr Surg. 2010;  125 1735-1743
  • 30 Chen S L, Chuang C J, Chou T D, Chen T M, Wang H J. Free medial sural artery perforator flap for ankle and foot reconstruction.  Ann Plast Surg. 2005;  54 39-43
  • 31 Parrett B M, Winograd J M, Lin S J, Borud L J, Taghinia A, Lee B T. The posterior tibial artery perforator flap: an alternative to free-flap closure in the comorbid patient.  J Reconstr Microsurg. 2009;  25 105-109
  • 32 Jakubietz R G, Jakubietz M G, Grünert J G, Kloss D F. [Soft tissue coverage of the distal third of the tibia with fasciocutaneous propeller flaps].  Zentralbl Chir. 2008;  133 391-395
  • 33 Pignatti M, Pasqualini M, Governa M, Bruti M, Rigotti G. Propeller flaps for leg reconstruction.  J Plast Reconstr Aesthet Surg. 2008;  61 777-783
  • 34 Teo T C. Perforator local flaps in lower limb reconstruction.  Cir Plást Iberlatinamer. 2006;  32 15-16
  • 35 Noack N, Hartmann B, Küntscher M V. Measures to prevent complications of distally based neurovascular sural flaps.  Ann Plast Surg. 2006;  57 37-40
  • 36 Wong C H, Tan B K. Intermittent short saphenous vein phlebotomy: an effective technique of relieving venous congestion in the distally based sural artery flap.  Ann Plast Surg. 2007;  58 303-307
  • 37 Lineaweaver W C, Lei M P, Mustain W, Oswald T M, Cui D, Zhang F. Vascular endothelium growth factor, surgical delay, and skin flap survival.  Ann Surg. 2004;  239 866-873 discussion 873-875
  • 38 Verhelle N, Van Zele D, Liboutton L, Heymans O. How to deal with bone exposure and osteomyelitis: an overview.  Acta Orthop Belg. 2003;  69 481-494
  • 39 Ghali S, Bowman N, Khan U. The distal medial perforators of the lower leg and their accompanying veins.  Br J Plast Surg. 2005;  58 1086-1089
  • 40 Verhelle N, Vranckx J, Van den Hof B, Heymans O. Bone exposure in the leg: is a free muscle flap mandatory?.  Plast Reconstr Surg. 2005;  116 170-177 discussion 178-181

Xinzhong ShaoM.D. Ph.D. 

Hand Surgery Department, Third Hospital of Hebei Medical University

Shijiazhuang, Hebei 050051, China

Email: shaoxinzhong@sina.com

    >