Free flap pedicled with peroneal artery perforator to repair soft tissue defects at hands and feet

Abstract

Objective To explore the clinical effects of free flap pedicled with peroneal artery perforator in repair of soft tissue defects at hands and feet. Methods From July 2010 to December 2012, 36 patients with soft tissue defects at hands and feet were repaired by free flaps pedicled with peroneal artery perforator. They were 30 men and 6 women, 21 to 50 years of age (average, 32.6 years). Twenty-one pa-tients had skin defects at distal 1/3 dorsum of foot; of the 15 patients with hand soft tissue defects, 8 had skin defects and tendon exposure at dorsum of hand, 3 had skin defects between the thumb and the index finger, and 4 had skin defects and tendon exposure at the palm. The defective areas varied from 3.0 cm×2.0 cm to 8.5 cm×4.0 cm, the flap harvesting area varied from 4.0 cm × 3.0 cm to 10.0 cm × 5.0 cm. the time from injury to operation was from 3 to 78 hours (average, 12.8 hours). Twenty-nine flaps were pedicled with intramuscular perforating branches, and 6 with intermuscular perforating branches. The blood vessels were anastomosed end to end. The function of affected limbs in the 15 cases of hand soft tissue defect was evaluated at the last follow-up according to the criteria by Hand Surgery Society, Chinese Medical Association (HSSCMA); the 21 patients with soft tissue defect of the feet was evaluated according to criteria by Japanese Orthopaedic Association (JOA); the functional recovery of skin sensation in the 36 patients was evaluated according to the criteria by British Medical Research Council (BMRC). Results All the transferred free flaps survived uneventfully. The 36 patients were followed up for 6 to 24 months (average, 11 months). The flaps showed no pigmentation but fine texture, appearance, and wear-resistance. According to HSSCMA cri-teria, the function of affected limbs was excellent in 12 cases, good in 2 and fair in one. According to JOA criteria the 21 patients with soft tissue defect of the feet scored an average of 90.6 points (rang, from 80 to 98 points). According to BMRC criteria, the functional recovery of skin sensation was S3 to S4 in 25 cases, S2 in 9, and S1 in 2. The donor limbs showed no cicatricial contracture or dysfunction. Conclusions Free flaps pedicled with peroneal artery perforator are a good choice for repair of small or middle areas of soft tissue defect at hands and feet, because they are characterized by stable vascular anatomy, proper thickness, no damage to primary artery, slight injury to the donor site, and direct anastomosis. Key words: Surgical flaps; Soft tissue injuries; Hand; Foot