JOURNAL ARTICLE

[Repair of soft tissue defects of lower extremity by using cross-bridge contralateral distally based posterior tibial artery perforator flaps or peroneal artery perforator flaps]

Cunyi Fan, Hongjiang Ruan, Peihua Cai, Shen Liu, Fengfeng Li, Bingfang Zeng
Chinese Journal of Reparative and Reconstructive Surgery 2011, 25 (7): 826-9
21818949

OBJECTIVE: To discuss the feasibility of repairing soft tissue defects of lower extremity with a distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap.

METHODS: Between August 2007 and February 2010, 15 patients with soft tissue defect of the legs or feet were treated. There were 14 males and 1 female with a mean age of 33.9 years (range, 25-48 years). The injury causes included traffic accident in 8 cases, crush injury by machine in 4 cases, and crush injury by heavy weights in 3 cases. There was a scar (22 cm x 8 cm at size) left on the ankle after the skin graft in 1 patient (after 35 months of traffic accident). And in the other 14 patients, the defect locations were the ankle in 1 case, the upper part of the lower leg in 1 case, and the lower part of the lower leg in 12 cases; the defect sizes ranged from 8 cm x 6 cm to 26 cm x 15 cm; the mean interval from injury to admission was 14.8 days (range, 4-28 days). Defects were repaired with distally based posterior tibial artery perforator cross-bridge flaps in 9 cases and distally based peroneal artery perforator cross-bridge flaps in 6 cases, and the flap sizes ranged from 10 cm x 8 cm to 28 cm x 17 cm. The donor sites were sutured directly, but a split-thickness skin graft was used in the middle part. The pedicles of all flaps were cut at 5-6 weeks postoperatively.

RESULTS: Distal mild congestion and partial necrosis at the edge of the skin flap occurred in 2 cases and were cured after dressing change, and the other flaps survived. After cutting the pedicles, all flaps survived, and wounds of recipient sites healed by first intention. Incisions of the donor sites healed by first intention, and skin graft survived. Fifteen patients were followed up 7-35 months with an average of 19.5 months. The color and texture of the flaps were similar to these of the recipient site. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system, the mean score was 87.3 (range, 81-92).

CONCLUSION: A distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap is an optimal alternative for the reconstruction of the serious tissue defect of contralateral leg or foot because of no microvascular anastomosis necessary, low vascular crisis risk, and high survival rate.

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