Using the posterior tibial artery and peroneal artery perforator flaps to repair heel wounds: 18 cases report

Abstract

Objective To investigate the clinical efficacy of using the posterior tibial artery and peroneal artery perforator flaps to repair the heel wounds. Methods From January, 2011 to May, 2018, heel soft tissue defect caused by trauma in 18 cases were treated by posterior tibial artery and peroneal artery perforator flaps respectively. The posterior tibial artery perforator flap was used in 11 cases, and the peroneal artery perforator flap was used in 7 cases. The area of flaps ranged from 5.0 cm×3.0 cm to 11.0 cm×9.0 cm. The length of the vascular pedicle was from 10.0 cm to 16.0 cm. After operation, the patients were followed-up regularly. The time of wound healing, appearance and texture of the flap, and function of ankle joint were observed. Results After the operation, 13 flaps survived uneventfully. The wound achieved primary healing. Partial necrosis occurred in the distal of posterior tibial artery perforator flap in 2 cases, and repaired by skin graft 1 or 2 months later. Marginal necrosis occurred in posterior tibial artery perforator flap in 2 cases and in peroneal artery perforator flap in 1 case. And scar healing occurred in these 3 cases finally. All the 18 patients were followed-up for 3 to 60 months, with an average of 10 months. Fracture healing time was from 3-6 months, with an average of 4 months. Flap was soft with satisfied appearance in 16 cases. Obvious scar formation occurred in 2 cases. There was no obvious scar contracture in donor sites. There was no obvious limitation of the flexion and extension function of the ankle joint in 18 cases. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, there was excellent in 16 cases, and good in 2 cases. Conclusion As for the characteristics of the heel wound, it is a simple and practical method to use leg perforator flap to repair. The flap is based on a long vascular pedicle. And the clinical effect is satisfied. Key words: Posterior tibial artery; Peroneal artery; Perforator flap; Heel; Repair