Ankle anterior perforating flaps for reconstruction of soft tissue defects on dorsum of foot

Abstract

Objective To explore the clinical effects of ankle anterior perforating flaps in reconstruction of the soft tissue defects on dorsum of foot. Methods A retrospective cases series study was done to analyze 11 patients with dorsal skin soft tissue defects: eight males and three females, with age ranging from 18-76 years (mean, 43.5 years), treated from January 2009 to March 2017. The sizes of the soft tissues defects varied from 4.0 cm×3.5 cm to 15.0 cm×6.0 cm. According to the anatomical basis of ankle anterior perforating flaps, the sizes and shapes of the skin defects of the dorsal ankle, the flaps were designed and harvested in the anterior part of the lower leg to repair the dorsal skin soft tissue defects. The sizes of flaps ranged from 15.0 cm×6.0 cm to 4.0 cm×3.2 cm. The clinical effect was evaluated based on the flap survival, infection control, elasticity, color, appearance, scars of the donor sites, skin sensitivity and patient satisfaction. The extent of the flap swellings was also evaluated. Results All ten flaps survived after the surgery. Both the donor and recipient sites healed very well at I stage. One case had flap distal phalanx necrosis. After changing the ointments on time, both the donor and recipient sites survived completely. Duration of follow-up was 3-24 months (mean, 12 months). The flaps survived very well with good shape, and the color and elasticity were very close to the normal skin nearby. The scars of the donor sites were small and the functions of ankle and foot were satisfactory. Satisfaction extents of treatment efficacy were good in nine patients and general in two, with no unsatisfaction. Flap swelling classification were nine cases of degree II and two cases of degree III in early stage while 11 cases of degree I in later stage. Conclusions The ankle anterior perforating flap has constant perforating blood vessels, reliable blood supply, high survival rate of flaps and hence is one of the simple, safe and optimal ways to repair the dorsal skin soft tissue defects. Key words: Foot injuries; Surgical flaps; Ankle anterior perforator vessels