Clinical application of proximal periosteal perforator bone-skin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot

Abstract

Objective To investigate the clinical efficacy of proximal periosteal perforator bone-skin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot. Methods March 2015 to October 2017, 24 cases of the composite tissue defects of the hand and foot were repaired by free transplantation of the proximal periosteal perforator bone-skin flap of anterior tibial artery, including 12 cases of hand and 12 cases of foot. There were 6 cases of tendon injury and 1 case of joint defect. The skin defect area ranged from 3.0 cm × 0.8 cm to 10.0 cm × 5.5 cm. The size of bone defects ranged from 1.7 cm×1.5 cm ×1.0 cm to 5.0 cm×1.0 cm×1.0 cm. The anterior tibial margin of the talus-tibial tubercle (3.2 ±0.8) cm was the penetrating point, and the bone-skin flaps were designed with this as the center. After operation, hand function was followed up according to Michigan Hand Function Evaluation Standard, and foot function was evaluated according to Maryland Foot Score Standard. Results All the flaps survived, of which 21 cases were follow-up for 6 to 24 months, with an average of 12.3 months, and 3 cases were lost. The skin flaps were soft, elastic, moderately thick and nearly normal skin. At the last follow-up, the sensation of the flaps restored to S2 to S3. The two-point discrimination was 6 to 11 mm, with an average of 8.9 mm. Two-stage thinning operation of fingertip flaps was performed in 3 cases. Finger shape and function recovered well. The healing time of the transplanted bone and skin flaps ranged from 2 to 4 months, with an average of 2.3 months. No delayed or nonunion occurred. There was no influence on leg and foot weight-bearing walking. Michigan hand function score was excellent and good in 8 cases and Maryland foot score was excellent and good in 12 cases. Conclusion The proximal periosteal perforator of anterior tibial artery has a constant position. Its bone and skin flaps are suitable for repairing small and medium-sized composite tissue defects in hand and foot. Key words: Surgical flaps; Treatment outcome; Anterior tibial artery; Periosteal perforator; Composite tissue defects