The clinical types and application of perforator branches of anterosuperior malleolus flap

Abstract

Objective To introduce the clinical types of perforator branches of anterosuperior malleolus flap and explore its application. Methods Anterosuperior malleolus flap coupling with dorsal pedal flap was used for repairing the soft tissue defect of hands in 18 patients, in which anterosuperior malleolus flap-dorsal pedal single flap in 12 cases, anterosuperior malleolus flap-dorsal pedal bilobate flap in 4 cases, anterosuperior malleolus flap-dorsal pedal trilobate flap in 2 cases; Anterosuperior malleolus retrograde island (bone) flap was used in recovering pedal soft tissue in 22 patients, the flap pedicled from stem of anterior tibial artery in 16 cases, dorsal pedal flap-anterosuperior malleolus flap in 2 cases, the flap from perforate vessels without injuring the anterior main tibial artery in 2 cases, the bone flap combined with the distal of tibia in 2 cases. Results In the 18 cases of hands, 17 cases survived, and 1 case of flap mild necrosis at the distal site took a second-phase skin-grafting to repair. Twenty cases of anterosuperior malleolus retrograde island (bone) flap survived, and the other 2 cases needed secondary skin-grafting to repair the necrosis edge of flaps because of venous limited. After a follow-up from 3 to 6 months, 30 cases showed the satisfied postoperative outlook, with the good healing of the donor sites. Typing the 40 cases according to the location of perforator branches of the anterosuperior malleolus flap, 20 cases locate in the medial of anterior tibial muscle, 16 cases locate between the anterior tibial muscle and extensor hallucis longus, 4 cases locate between extensor hallucis longus and extensor digitorum longus. Conclusion Knowing the clinical types of the perforator branches of anterosuperior malleolus flap is not only helpful for the accurate processes of operations、preventing cutaneous branches, but also improving the success rate of surgery. Key words: Anterosuperior malleolus flap; Perforator flap; Perforator branches; Clinical type; Microsurgery