Repairing soft tissue defect in forefoot by a retrograded lateral tarsal artery perforator flap pedicled with anterior branch

Abstract

Objective To investigate the surgical method and clinical effect of repairing the forefoot soft tissue defect by the retrograded lateral tarsal artery perforator flap pedicled with the anterior branch. Methods From March, 2015 to October, 2018, 9 patients with soft tissue defects in forefoot were repaired by the retrograded lateral tarsal artery perforator flap pedicled with anterior branch. One patient received an emergency repair and 8 received secondary repair. The wounds were all located in the forefoot. Area of defects were 3.0 cm×2.0 cm-5.0 cm×4.0 cm; flap areas were 3.5 cm×3.0 cm-6.0 cm×4.5 cm. The donor sites of flap were repaired with full thickness skin graft. All patients received postoperative followed-up through the visits of outpatient clinics, WeChat or telephone reviews. Results Eight flaps survived successfully and the wounds healed by first intention; One flap had venous crisis 2 days after surgery and after having removed stitches of the pedicle of flap, only distal skin necrosis occurred. And healed after changing treatment. All the skin graft in donor sites of flaps survived well. All patients were entered 3 to 18 months postoperative follow-up. The shape of flaps had good textures and were not bloated. The sensation of flaps partially recovered. In the last followed-up, 8 flaps were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) middle foot scoring standard. The results were excellent in 5 cases, good in 2 cases and poor in 1 case, with the good and excellent rate of 87.5%. Conclusion The retrograde lateral tarsal artery perforator flap pedicled with the anterior branch is one of the effective methods to repair the soft tissue defect in forefoot without damaging the main trunk of dorsal pedal artery. It features a reliable blood supply to the flap and a relatively simple surgical procedure. Key words: Lateral tarsal artery perforator flap; Anterior branch; Forefoot; Repair