[Clinical application of free peroneal perforator-based sural neurofasciocutaneous flap]

Peihua Cai, Shenghe Liu, Haiming Wang, Hongjiang Ruan, Yimin Chai
Chinese Journal of Reparative and Reconstructive Surgery 2008, 22 (6): 724-7

OBJECTIVE: To investigate the operative techniques and clinical results of repairing the soft tissue defects of forearm and hand with free peroneal perforator-based sural neurofasciocutaneous flap.

METHODS: From May 2006 to January 2007, 6 patients including 5 males and 1 female were treated. Their ages ranged from 22 years to 51 years. They were injured by motor vehicle accidents (2 cases), or crushed by machines (4 cases), with skin defect of hand in 1 case, skin defect of hand associated with tendon injuries and metacarpal fractures in 2 cases, skin defect of forearm in 2 cases, and forearm skin defects with fractures of radius and ulna in 1 case. The areas of soft tissue defect ranged from 16 cm x 7 cm to 24 cm x 10 cm. The debridement and the primary treatment to tendons or bones were performed on emergency. And free flaps were transplanted when the wound areas were stable at 4 to 7 days after the emergent treatment. During the operation, the flaps were designed along the axis of the sural nerve nutrient vessels according to the shape and size of the soft tissue defects, with the peroneal perforator above the lateral malleolus as the pedicle and along with a part of the peroneal artery for vascular anastomosis. Then the flaps were harvested and transferred to the recipient sites with the peroneal varley anastomosed to the radial (or ulnar) artery and the peroneal veins to one of the radial (or ulnar) veins and the cephalic vein, respectively. The flap size ranged from 18 cm x 8 cm to 25 cm x 12 cm. The donor areas were closed by skin grafts.

RESULTS: The 5 flaps survived after the surgery. Partial inadequate venous return and distal superficial necrosis happened in only 1 case, which also got secondary healing by changing dressing and anti-infective therapy. The donor sites reached primary healing completely. The followed-up in all the patients for 6 to 13 months revealed that the appearance and function of the flaps were all satisfactory, and no influence on ambulation of donor site was found.

CONCLUSION: Peroneal perforator-based sural neurofasciocutaneous flap has the advantages of favourable appearance, constant vascular pedicle, reliable blood supply, large size of elevation and minor influence on the donor site. And the free transfer of this flap is an ideal procedure to repair the large soft tissue defects of forearm and hand.

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