Application of lateral malleolus perforator island flap on repairing plantar soft tissue injury

Abstract

Objective To explore the method and clinical effect of repairing the soft tissue injury of the plantar using perforator island flaps pedicled with the perforator branch of the lateral malleolus. Methods From September 2014 to December 2016, 10 patients (among them 6 patients from Beijing Chaoyang Emergency Rescue Center, and 4 patients from No. 464 Hospital of PLA) including 6 males and 4 females with plantar soft tissue defect were repaired with the island flap of the superior perforator branch of the lateral malleolus. The average age was 34.4 years old (20.0-56.0 years old). Among them 6 patients were machine injury, 2 patients were traffic accident injury and 2 patients were heavy objects injury. The defect area ranged from 2.5 cm×3.5 cm to 10.0 cm×12.0 cm, and the area of repaired island flap with perforator branch of the superior lateral malleolus ranged from 3.0 cm×4.0 cm to 11.0 cm×14.0 cm. The width of donor wound less than 3 cm can be directly sutured, and the rest were repaired with intermediate split thickness skin graft. Ten patients were followed up through telephone, Wechat and outpatient review. The healing of donor site incision and the survival of skin graft were observed for evaluating the recovery of donor site; the appearance, sensation of skin flap, and the weight-bearing walking were observed for evaluating the recovery of recipient site. Results All patients were followed up for 4.0-12.0 months after operation, with an average of 8.4 months. All the flap survived in the 10 patients. Nine patients wound healed in the first stage. Necrotic of distal edge of the flap happened in 1 patient and then healed after dressing change. The donor site healed well and all the skin grafts survived. The flap was satisfactory in appearance, soft in texture, without obvious swelling, and returned to protective sensation after half a year (S2), without ulcer formation, and without pain and discomfort when walking in shoes. Conclusions The superior perforator branch of lateral malleolus island flap is moderate in thickness, reliable in blood supply, easy to harvest without sacrificing the main artery. It can carry the cutaneous nerve and the recipient cutaneous nerve anastomosis, restore the plantar protective sensation. It is one of the effective methods to repair the plantar soft tissue defect. Key words: Surgical flaps; Foot; Ankle; Wounds and injuries; Repair