Repair of composite tissue defect of lower extremity with free fibula composite tissue flaps assisted by 3D-CT angiography

Abstract

Objective To investigate the clinical efficacy of free fibula composite tissue flap transplantation for repair of composite tissue defects of lower extremity assisted by three-dimensional CT angiography (3D-CTA). Methods From May 2013 to February 2018, 16 patients with severe lower extremity trauma were treated with fibular composite tissue flaps. The course, distribution and vascular variation of peroneal artery were determined by preoperative 3D-CTA. The survival and appearance of the flaps were observed after the operation. X-ray examination was performed 6 weeks, 3 months, 6 months and 1 year after the operation to observe the healing of the fracture and evaluate the functional recovery of the affected limbs. Results The anatomical structure of composite tissue flaps can be clearly displayed by 3D-CTA. The findings during operation were basically consistent with the preoperative design. The follow-up period ranged from 6 to 24 months, with an average of 13 months. All the flaps survived and the fracture healed well. According to Enneking system score the average point was 22. The lower extremity function recovered to 73% of that of the normal side. Ankle joint activity was normal in donor area, and there was no abnormal sensation in common peroneal nerve innervation area. Conclusion At the same time of repairing bone defects with free composite tissue flaps, the combined skin flaps can repair soft tissue defects, which effectively solve the problem of wound coverage and restore the function of affected limbs. The patients are satisfied with the prognosis. Key words: Lower extremity; Treatment outcome; Three-dimensional CT angiography; Fibula composite tissue flap