[Application of distal peroneal perforator-based superficial peroneal neurofasciocutaneous flap for repairing donor site defect of forefoot]

Zongjun Li, Chunling Xiao, Jianxin Yin, Yimin Chai
Chinese Journal of Reparative and Reconstructive Surgery 2009, 23 (2): 209-11

OBJECTIVE: To investigate the operative techniques and clinical results of the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery in repairing donor site defect of forefoot.

METHODS: From March 2005 to October 2007, 15 patients (11 males and 4 females, aged 20-45 years with an average of 33.6 years) with finger defects resulting from either machine crush (12 cases) or car accidents (3 cases) were treated, including 12 cases of thumb defect, 2 of II-V finger defect and 1 of all fingers defect. Among them, 6 cases were reconstructed with immediate toe-to-hand free transplantation after injury, and 9 cases were reconstructed at 3-5 months after injury. The donor site soft tissue defects of forefoot were 6 cm x 4 cm-12 cm x 6 cm in size, and the superficial peroneal neruofasciocutaneous flaps ranging from 10 cm x 4 cm to 14 cm x 6 cm were adopted to repair the donor site defects after taking the descending branch of the distal perforating branch of peroneal artery as flap rotation axis. The donor sites in all cases were covered with intermediate split thickness skin grafts.

RESULTS: All flaps survived and all wounds healed by first intention. All reconstructed fingers survived completely except one index finger, which suffered from necrosis. Over the 6-18 months follow-up period (mean 11 months), the texture and appearance of all the flaps were good, with two-point discriminations ranging from 10-13 mm, and all patients had satisfactory recovery of foot function. No obvious discomfort and neuroma were observed in the skin-graft donor sites. The feeling of all the reconstructed fingers recovered to a certain degree, so did the grabbing function.

CONCLUSION: Due to its reliable blood supply, no sacrifice of vascular trunks, favorable texture and thickness and simple operative procedure, the superficial peroneal neurofasciocutaneous flap based on the distal perforating branch of peroneal artery is effective to repair the donor site defect in forefoot caused by finger reconstruction with free toe-to-hand transplantation.

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