Dorsum Of Foot Research Articles

Longitudinal physiological remoulding of lower limb skin as a cause of diabetic foot ulcer: a histopathological examination.

Diabetic foot ulcer (DFU) is recognised as a severe complication in patients with type 2 diabetes. With the increasing incidence of diabetes, it represents a major medical challenge. Several models have been proposed to explain its aetiology; however, they have never been assessed by longitudinal histopathological examination, which this study aims to address. Multiplex-immunofluorescence analysis was carried out with lengthwise serial skin specimens obtained from the medial thigh, lower leg, ankle, dorsum of foot and acrotarsium close to the DFU region of a patient with type 2 diabetes receiving above the knee amputation. Proximal-to-distal gradual loss of peripheral nerve was demonstrated, accompanied by compromised capillaries in the superficial papillary plexus and distended CD31-positive capillaries in the dorsum of foot. Neural fibres and capillaries were also significantly compromised in the sweat gland acinus in the ankle and dorsum of foot. Injuries in the superficial papillary plexus, sweat gland acinus, and sweat gland-associated adipose tissues were accompanied by significant infiltration of macrophages. These results indicated that longitudinal impairment of local blood circulation could be the cause of peripheral neuropathy, which initiated ulcer formation. Resultant chronic inflammation, involving sweat gland-associated adipose tissue, gave rise to impairment of wound healing, and thus DFU formation. Longitudinal histopathological examination demonstrated that impairment of local microvascular circulation (rather than the systemic complication caused by type 2 diabetes) was considered the primary cause of peripheral neuropathy, which initiated ulceration. Together with chronic inflammation in the superficial papillary plexus and sweat gland-associated adipose tissue, it resulted in the development of a DFU. Although this is a study of just one individual's limb, our study provided a unique observation, contributing mechanistic insights into developing novel intervening strategies to prevent and treat DFUs.

Aneurysm of the lateral marginal vein of the foot

Superficial venous aneurysms are a very rare pathology. This case report describes a 21-years-old male patient, who developed a soft, slow-growing mass, in the lateral part of the dorsal foot. Based on clinical examination and EcocolorDoppler ultrasound exam, the diagnosis of venous aneurysm of the lateral marginal vein was confirmed. The treatment proposed was ultrasound-guided foam sclerotherapy. The purpose of this work is to describe for the first time a venous superficial aneurysm localized in the lateral marginal vein of the foot. It is the first case reported in English literature.

Soft tissue reconstruction of foot and ankle defect using various flap cover: single centre experience

Introduction: Soft tissue defect at ankle and foot region are very common following road traffic accident. Reconstruction in this region is challenging to surgeon because of poor vascularity and paucity of available surrounding tissue. Purpose of study is to evaluate various ankle and foot defect, advantage and disadvantages of different methods of management, future prospective of suitable method according to defect.Materials and Methods: Retrospective study of 65 patients with soft tissue defects around foot and ankle region underwent various reconstructive procedures at SMS hospital Jaipur from January 2020 to December 2020. Study enumerates various etiological factors and describes different reconstructive surgical procedures.Results: Age at presentation range from 8 to 63 years and males were more common. Road traffic accident is most common cause for defect at foot and ankle region followed by diabetic foot and orthopedic implant exposure. Most common site of defect in foot and ankle defect were dorsum of foot followed by lateral malleolus region. Free ALT flap cover performed most frequently followed by cross leg flap.Conclusion: Reverse sural flap is reliable option for small ankle and foot defect near ankle. Cross leg flap is also most reliable option for large defect in opposite healthy limb. Reverse saphanous flap also used for small defects on medial side ankle. Larger defect of ankle and foot can be covered by free fasciocutaneous or myocutaneous flaps where microsurgical expertise available.

Bullous Tinea Pedis

A woman in her 70s presented with a skin eruption on the left dorsal foot that had developed spontaneously 2 weeks before. The rash initially appeared with pruritic papules that evolved to fluid-filled blisters and persisted despite self-treatment with topical hydrocortisone 1% cream and antibiotic ointment. Examination revealed an erythematous plaque with tense and denuded bullae (Figure 1). She received oral cephalexin for presumed bullous impetigo. Bacterial culture and herpes simplex virus and varicella zoster virus polymerase chain reaction (PCR) swab results were negative.

Skin infection by Mycobacterium farcinogenes–senegalense group in an immunocompetent patient: a case report

BackgroundMycobacterium farcinogenes–senegalense group mostly cause bovine farcy, which rarely infect human beings. We reported one case of cutaneous Mycobacterium farcinogenes–senegalense group infection in an immunocompetent victim.Case presentationA 66-year-old Taiwanese woman with hypertension developed tender nodules on her left dorsal foot for 2 months. Tissue culture identified Mycobacterium farcinogenes–senegalense group. The lesion was treated successfully with clarithromycin and sulfamethoxazole/trimethoprim, followed by surgical excision.ConclusionsMycobacterium farcinogenes–senegalense group infection should be considered as a potential pathogen of skin infection in immunocompetent patients.

Application of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity

To explore the feasibility and effectiveness of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Between July 2015 and July 2021, 10 patients with soft tissue defect of distal lower extremity were treated with perforator propeller flap sequential transfer technique. There were 8 males and 2 females, with a median age of 47 years (range, 6-71 years). The etiologies included malignant tumor in 5 cases, trauma in 3 cases, postburn scar contracture in 1 case, and diabetic foot ulcer in 1 case. The defects were located at the pretibial area in 1 case, the distal lower extremity and Achilles tendon in 3 cases, the dorsum of foot and lateral malleolar area in 4 cases, the heel in 1 case, and the plantar foot in 1 case. The size of the defect ranged from 5 cm×3 cm to 8 cm×8 cm. Peroneal artery perforator propellor flaps (the 1st flap) in size of 14 cm×4 cm to 29 cm×8 cm were used to repair the defects of distal lower extremity. The donor site defects were repaired with the other perforator propeller flaps (the 2nd flap) in size of 7 cm×3 cm to 19 cm×7 cm. The donor site of the 2nd flap was directly closed. All the operations were successfully completed and all of the 2nd flaps were elevated within 1 hour. Eight the 1st flaps survived completely; 2 had venous congestion. Among the 2 patients with venous congestion, 1 had necrosis of the distal end of the flap, and the secondary wound was repaired by skin grafting; 1 recovered spontaneously after 7 days. The 2nd flaps totally survived. No complication such as hematoma or infection occurred. Primary closure was achieved in all the recipient and donor sites. All patients were followed up 2-39 months，with a median of 15.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. The normal contour of the leg was preserved. During follow-up, no recurrence of malignance or ulcer was observed. The scar contracture was completely released. All patients were satisfied with the reconstructive outcomes. The application of the perforator propeller flap sequential transfer technique can improve the repair ability of the lower extremity perforator propeller flap while ensuring the first-stage closure of the donor site, thereby improving the effectiveness.

A Preliminary Study on Infrared Thermograph of Metabolic Syndrome.

ObjectiveTo explore the temperature distribution characteristics of the face, palms, feet and the trunk area of metabolic syndrome (MS) through infrared thermography (IRT) and provide evidence for the application of IRT in the assistant evaluation of MS population.MethodsWe collected thermographs of 184 participants (91 males, 93 females) and further divided participants of each gender into 4 groups according to the number of abnormal metabolic indexes. Mean temperatures of 6 Region of Interests (ROIs) (face, anterior trunk, bilateral palms and dorsum of feet) were calculated. Comparisons of the mean temperatures between genders, among groups and ROIs were carried out.ResultsMale participants had higher mean temperature in their face, palms (P<0.01) and dorsum of feet (P<0.05), and lower mean temperature in the anterior trunk (P<0.01). Female participants with MS had higher mean temperature in their palms and dorsum of feet (P<0.01) and lower mean temperature in the anterior trunk (P<0.01) than normal participants. Similar tendencies were shown in the mean temperature of the left palms and trunk of MS males. With the increase of the number of abnormal metabolic indexes, it seems that the mean temperature gradually increased in palms and dorsum of feet, and decreased in the anterior trunk.ConclusionThe thermograph of MS exhibits certain characteristics. This may help reveal the correlations between Infrared thermography and metabolic disorders.

The Patency of Tibial/Peroneal Arteries Affects the Increment of Regional Tissue Saturation of Oxygen in Each Angiosome after Superficial Femoral Artery Revascularization.

Objective: The angiosome model is a controversial concept in the revascularization of patients with chronic limb-threatening ischemia (CLTI). The aim of this study was to demonstrate the importance of patency of the tibial/peroneal arteries for regional tissue oxygenation in each angiosome during endovascular therapy (EVT) of the superficial femoral artery (SFA).Materials and Methods: We devised a novel near-infrared spectroscopy oximeter, “TOE-20,” for real-time monitoring of regional tissue oxygen saturation (rSO2). Using TOE-20, we prospectively assessed rSO2 at each angiosome in 23 CLTI patients who underwent successful revascularization of the SFA. During EVT, three sensor probes were placed at the dorsal foot, plantar foot, and outer ankle for rSO2 monitoring.Results: At the end of EVT, rSO2 at all angiosomes was significantly elevated by SFA revascularization. The change in rSO2 in each angiosome was larger in patients with patent relevant arteries than in those with occluded relevant arteries (i.e., anterior tibial artery patency, posterior tibial artery patency, and peroneal artery patency).Conclusion: The patency of the tibial/peroneal arteries is important for regional tissue oxygenation in EVT. Using TOE-20 and rSO2-based revascularization, it may possible to anticipate whether an ischemic ulcer will heal or not.

Musculoskeletal manifestations of leprosy.

A 32-year-old lady presented with a 1-month history of recurrent painful nodules over her legs and forearms (Fig. 1A), bilateral symmetric small- and large-joint polyarthritis, swelling of dorsal hands and feet, and dactylitis (Fig. 1B–D). The possibilities of sarcoidosis, tuberculosis, leprosy, SLE, lymphomatoid granulomatosis, and s.c. panniculitis-like T-cell lymphoma were considered. The patient did not have constitutional symptoms, lymphadenopathy, pulmonary or ocular involvement, thickened nerves, or an anaesthetic skin patch, and had no relevant medical family history. A skin biopsy from a nodule showed granulomatous inflammation of foamy macrophages and lymphocytes surrounding the neurovascular bundle (Fig. 1E). Her haemogram, liver and renal function tests, and electrolytes were normal. Her ESR was 42 mm and CRP 24.7 mg/dl, and RF, anti-cyclic citrullinated peptide antibody, ANA, serum angiotensin-converting enzyme levels, and viral markers were negative. A slit skin smear and PCR for Mycobacteriumleprae were positive. A diagnosis of lepra reaction—erythema nodosum leprosum with swollen hands and feet was made. She was treated with prednisolone (40 mg/day) and multidrug therapy (rifampicin, clofazimine and dapsone). All symptoms improved within days to weeks of starting treatment. Musculoskeletal manifestations in leprosy can either present acutely—lepra reaction, swollen hands and feet syndrome, tenosynovitis—or chronically—symmetric polyarthritis as in RA or Charcot’s arthropathy, and can mimic various rheumatic diseases [1]. Arthritis with skin nodules is rarely an initial presentation of Hansen's. Thickened nerves, anaesthetic skin patches, ear lobule infiltration, and anti-cyclic citrullinated peptide antibody levels may help in differentiating [2].

Effectiveness of groin flap with external oblique aponeurosis for tendon and skin defects of dorsal foot

To investigate the effectiveness of groin flap with external oblique aponeurosis in repair of tendon and skin defects of dorsal foot. Between October 2016 and January 2020, 12 patients with compound tissue defects of the dorsal foot caused by trauma were treated. There were 9 males and 3 females, with a median age of 42 years (range, 32-65 years). The size of the skin defects ranged from 8 cm×5 cm to 12 cm×8 cm. All wounds were accompanied by extensor tendon injury, including 6 cases of extensor hallucis longus tendon defect, 5 cases of extensor digitalis longus tendon defect, and 3 cases of extensor digitalis longus tendon and extensor digitorum brevis defects. The interval between injury and admission was 1-6 hours (mean, 3 hours). After admission, the wounds were thoroughly debrided, and the groin flap with external oblique aponeurosis was used to repair the skin and tendon defects in the second stage. The size of skin flap ranged from 10 cm×6 cm to 13 cm×9 cm, and the size of the external oblique aponeurosis ranged from 5.5 cm×3.0 cm to 8.0 cm×5.0 cm. The wounds at donor sties were sutured directly. All flaps survived completely without significant complications. All incisions of the recipient and donor sites healed by first intention. All patients were followed up 16-24 months (mean, 18 months). The flaps were satisfactory in appearance and soft in texture. At last follow-up, 9 cases were excellent and 3 cases were good according to the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal joint scale criteria. The toe function was satisfactory. The line scar was left without hernia or other morbidity on the donor site. The groin flap with the external oblique aponeurosis can repair the tendon and skin defects of the dorsal foot, with concealed donor site, easy dissection and adjustable thinness, as well as the enough tough aponeurosis.

Patterned depigmentation over the dorsum of feet

Patterned depigmentation over the dorsum of feet

Management of Lumbo-Sciatica Syndrome Through Ayurveda: A Case Study

Lumbo-sciatica Syndrome is L4-L5, L5-S1 disc radicular conflicts, it is because of injury or compression of sciatica nerve. Pain is originated from lower back, radiates downward to buttocks, posterior of thigh, below knee &amp; up-to dorsum of foot either one or both legs. It’ s symptoms are very close to GRIDHRASI in Ayurveda Text which is also a neurological disorder &amp; characterised by STAMBHA (Stiffness), RUKA (Pain), TODA (Pricking Sensation), from hip &amp; gradually radiating towards waist, back thigh &amp; calf region with frequent pulsation feels at these sites.

New proposal for skin grafts on tendon-exposed wounds.

Performing a skin graft is not feasible for tendon-exposed defect reconstruction because tendons are fibrous connective tissues with relatively poor blood supply. This study proposes a method to effectively perform skin graft surgery in tendon-exposed wounds. A 48-year-old male patient with diabetes mellitus had a very large left dorsal foot defect (8×8 cm). The wound bed had healthy granular tissue, with tendon exposure. The tendons were turned over so that the posterior side would behave as the anterior side. The edge of the paratenon was then fixed together to the surrounding granulation tissue or dense remnant fascia using absorbable sutures, and the close granulation tissue was approximated and buried. A split-thickness skin graft was performed after 1 week. The graft site was stably taken on postoperative day 3. A small disruption was then observed at the graft site within 1 week postoperatively, but conservative treatment was continued for 1 month, after which the defect site was completely restored. This technique can increase the success rate of skin grafts for defects with tendon exposure.

Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China.

Peripheral arterialdisease (PAD) can result in diabetic foot ulcers, gangrene, and even amputation. Since most cases of PAD in diabetic patients are associated with peripheral neuropathy, the symptoms of vascular disease are easily concealed by the symptoms of neuropathy and are ignored by people, so it is critical for health care providers to screen PAD for the diabetes patients. This study was carried out to identify theprevalence and related factors of PAD in diabetes mellitus inpatients. This was a cross-sectional observational study. A total of 855 patients were enrolled in the study from December 2018 to December 2019. The patients were divided into a non-PAD group (ABI = 0.9-1.3) and a PAD group (ABI <0.9). Logistic multivariate regression analysis showed that age, LDL-C, dorsalis pedis artery pulsation (left foot), and sensory-current threshold (right foot) were related factors for peripheral arterial disease. Patients who are older and have a higher LDL-C level, abnormal dorsal foot pulse, and abnormal sensory-current threshold must be vigilant, and receive early screening for PAD diagnosis and treatment to avoid a malignant outcome. In clinical work, medical staff should actively apply PAD screening to diabetic patients, identify risk factors as early as possible, conduct early interventions, reduce the risk of PAD in patients, and avoid the occurrence of adverse outcomes.

Treatment of Navicular Stress Fracture Accompanied by Os Supranaviculare: A Case Report

Navicular stress fractures (NSFs) are relatively uncommon, and predominantly affect athletes. Patients complain of vague pain, bruising, and swelling in the dorsal aspect of the midfoot. Os supranaviculare (OSSN) is an accessory ossicle located above the dorsal aspect of the talonavicular joint. There have been few previous reports of NSFs accompanied by OSSN. Herein we report the case of a patient with OSSN who was successfully treated for an NSF. A 34-year-old Asian man presented with a 6-month history of insidious-onset dorsal foot pain that occasionally radiated medially toward the arch. The pain worsened while sprinting and kicking a soccer ball with the instep, whereas it was temporarily relieved by rest for a week and analgesics. Plain radiographs of the weight-bearing foot and ankle joints revealed a bilateral, well-corticated OSSN. Computed tomography (CT) revealed a sagittally oriented incomplete fracture that extended from the dorsoproximal cortex to the center of the body of the navicular. The OSSN was excised and the joint was immobilized with a non-weight-bearing cast for 6 weeks, followed by gradual weight bearing using a boot. The 5-month follow-up CT scan demonstrated definite fracture healing. At the 1-year follow-up, the patient’s symptoms had resolved, the American Orthopedic Foot and Ankle Society midfoot score had improved from 61 to 95 points, and the visual analog scale pain score had improved from 6 to 0. We describe a rare case of NSF accompanied by OSSN. Because of the fracture gap and biomechanical properties of OSSN, OSSN was excised and the joint was immobilized, leading to a successful outcome. Further research is required to evaluate the relationship between NSFs and OSSN, and determine the optimal management of NSFs in patients with OSSN.

Case Report on Cellulitis

Introduction: Cellulitis is a bacterial infection that causes an inflammatory condition of the skin that affects the dermis and subcutaneous tissues. 2016 (Lee and Levell). Cellulitis of the lower limbs is a potentially dangerous condition (Halpern et al, 2008). Rubor or erythema, which is warm to the touch and often combined with a degree of localised oedema, is the most common symptom. However, because diagnosis is dependent exclusively on clinical data, it is commonly misdiagnosed [1]. There are a number of different illnesses that have symptoms that are similar to cellulitis. The purpose of this page is to provide information on the clinical symptoms of lower limb cellulitis as well as treatment options ensuring that practitioners are capable of making an accurate diagnosis and developing successful treatment programmes [2].&#x0D; Clinical Findings: Fever, pain over right lower leg, wound present right dorsal foot, weariness, malaise, and swelling were the patient’s main complaints.&#x0D; Diagnostic Evaluation: Haemoglobin 14.7%,total RBC count 4.77, total WBC count 16100, platelet count 1.56, KFT – UREA -57 CREATININE -2.0 potassium- 4.6, LFT ALKALINE PHOSPHATE -105, ALBUMIN3- 0 TOTAL BILIRUBIN- 1.4 micro report is normal. His liver function and coagulation studies were normal. A diagnostic work-up that includes blood cultures, dengue, malaria smear, typhoid, and other tests. The following tests were sent: leptospirosis, monospot and stool investigations, and Clostridium difficile PCR [3].&#x0D; Therapeutic Intervention: Four primary analgesic drugs, antibiotics drug in penicillin.&#x0D; Conclusion: My patient, a 65-year-old man, was hospitalised to the Hospital's medicine ward on June12, 2021.Fever, pain over right lower leg, wound present right dorsal foot, fatigue, malaise, and edema were among the symptoms that the patient had. His health improved when he received appropriate treatment. The patient was follow up after 1 weak [4].

Effects of Socks on the Dorsal Foot Contact Pressure during Gait with Shoes

Effects of Socks on the Dorsal Foot Contact Pressure during Gait with Shoes

Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients

BackgroundSoft tissue defects over the foot and ankle region are most challenging in reconstructive surgery. Sural artery and supramalleolar flaps have been commonly used for the reconstruction of non-weight-bearing surfaces of the foot. This article aimed to evaluate the long-term outcome comparisons between a sural artery and Supramalleolar flap in the reconstruction of extensive defects of foot and ankle only. MethodsBetween 1996 and 2020, a retrospective analysis of 53 fasciocutaneous flaps (27 sural and 26 Supramalleolar) used for reconstruction of soft tissue defects of foot and ankle were reviewed in this study. The parameters included were demographics data, causes, site and size of the defect, flap size, hospital stay, complications, and outcomes in a pre-structured proforma. The clinical outcome was assessed by a Self-Designed Tool based on flap survival, coverage of defect, weight-bearing status, functional activities of daily living, and cosmetic appearance. Data were analyzed through SPSS version 25. ResultsAmong 53 flaps, the major cause of the defect was Trauma (60.4%). The maximum flap size harvested was 25*10 for sural and 20*8 cm for supramalleolar. Complications were seen in 8 (15%) cases in both flaps. Flap tip necrosis and venous congestion were seen in 4 cases. 2 each in Supramalleolar whereas 1 partial necrosis, 1 venous congestion, and 2 infections were seen in the sural artery flap. The flap survival rate in both flaps was 96.2%. Based on the self-designed Tool, flaps were graded Excellent in 43, Good in 8, and Fair in 2 cases. There was no case of Poor in both flaps. ConclusionCompared with the sural artery flap, the lateral supramalleolar flap demonstrated higher rates of functional outcomes although flap tip necrosis was higher in Supramalleolar.

A comparative research of effect on inserting a distal perfusion catheter and preventive insertion of a distal perfusion catheter based on the limb ischemia risk assessment table in patients with extracorporeal membrane oxygenation

To compare the treatment effect of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) patients in the prophylactic distal perfusion catheter (DPC) and the non-prophylactic DPC. A prospective randomized controlled trial (RCT) was conducted. Patients who received VA-ECMO treatment were reviewed at Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2019 to June 2020 were divided into two groups, the prophylactic DPC group (DPC placed immediately after the patient VA-ECMO) and the non-prophylactic DPC group (the DPC was placed after the early limb ischemic signs by using evaluation of the lower extremity perfusion assessment table). Comparing the differences of clinical data of two group patients. Pearson correlation analysis was used to analyze the correlation between peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery and transcutaneous oxygen partial pressure (TcPO2). A total of 62 patients were included in the analysis, with 31 cases in prophylactic DPC group and another 31 cases in non-prophylactic DPC group. There were no significant differences in sex, age, body mass index (BMI), smoking index, underlying disease, catheterization site, recovery time before on machine, extracorporeal membrane oxygenation (ECMO) operation time, mechanical ventilation time, length of stay in intensive care unit (ICU), mortality rate in hospital, and acute physiology and chronic health evaluation II (APACHE II) between the preventive DPC group and the non-preventive DPC group. There was no significant difference in ECMO indications, ECMO intubation location and pipeline type. The bleeding in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [6.5% (2/31) vs. 29.0% (9/31), P < 0.05]. There were no significant differences in limb complications such as cyanosis, necrosis, amputation, compartment syndrome, arterial thrombosis, vascular reconstruction and repair, pseudoaneurysm, limb ischemic or limb infection. During the ECMO operation, except the blood stream infection in the non-prophylactic DPC group was lower than that in the non-prophylactic DPC group [3.2% (1/31) vs. 19.4% (6/31), P < 0.05], there was no other statistical difference in complications between the two groups. The peak velocity of dorsalis pedis artery in the preventive DPC group was significantly higher than that of the non-preventive DPC group (cm/s: 19.30±10.85 vs. 17.85±8.55, P < 0.05), and the peak velocity of posterior tibial artery was significantly lower than that of the non-preventive DPC group (cm/s: 19.90±10.94 vs. 21.58±9.77, P < 0.05). Pearson correlation analysis showed that the peak velocity of dorsalis pedis artery and peak velocity of posterior tibial artery of the preventive DPC group and the non-preventive DPC group were positively correlated with TcPO2 (r values were 0.747, 0.856, 0.850, 0.813, respectively, and P values were all 0.000). For patients with VA-ECMO treatment, the incidence of blood stream infection and bleeding during ECMO operation in non-prophylactic DPC implantation patients is lower than that of prophylactic DPC implantation patients. TcPO2 is positively correlated with peak velocity of posterior tibial artery and dorsal foot artery in the cannulated limb. In patients with VA-ECMO undergoing femoral artery and vein puncture,in addition to judging the blood supply of lower limbs according to symptoms and signs, ultrasound and TcPO2 monitoring can also be used as effective monitoring methods.

The lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries for repairing the large soft tissue defects on the foot and ankle

To investigate the effectiveness of the lower abdominal conjoined flap with bilateral superficial inferior epigastric arteries (SIEA) for repairing the large soft tissue defects on the foot and ankle. The clinical data of 18 patients with large soft tissue defects on foot and ankle treated between October 2017 and January 2020 were retrospectively analyzed, including 12 males and 6 females; the age ranged from 25 to 62 years, with a median age of 35 years. The causes of injury included machine injury in 9 cases, traffic accident injury in 5 cases, cutting injury in 2 cases, and electric injury in 2 cases. All wounds were accompanied by exposure of blood vessels, tendons, bones, and joints. Wound located at ankle in 8 cases, dorsum of foot in 6 cases, and sole in 4 cases. In the emergency department, complete debridement (the defect area after debridement was 15 cm×10 cm to 25 cm×16 cm) and vacuum sealing drainage on the wound was performed. The time from debridement to flap repair was 3-10 days, with an average of 5 days. According to the defect location and scope, the lower abdominal conjoined flap with bilateral SIEA was prepared. The size of the flap ranged from 15 cm×10 cm to 25 cm×16 cm. The length of vascular pedicle was 4.5-7.5 cm, with an average of 6.0 cm; the thickness of the flap was 0.5-1.2 cm, with an average of 0.8 cm. The abdominal donor site was closed in one-stage. One flap was altered as the conjoined flap with the bilateral superficial circumflex iliac artery because of the absence of the SIEA in one side. Except for 1 case of skin flap with distal necrosis, the flap healed after two-stage skin grafting repair; the rest skin flaps survived, and the wounds of the donor and recipient sites all healed by first intention. All patients were followed up 12-28 months, with an average of 16 months. The skin flap had a satisfactory appearance and soft texture, without abnormal hair growth or obvious pigmentation. Only linear scars were left at the donor site, and no complication such as abdominal hernia occurred. The foot and ankle function was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) scores were rated as excellent in 16 cases and good in 2 cases. The lower abdominal conjoined flap with bilateral SIEA is an ideal flap for repairing large defects of foot and ankle with less morbidity scarcely, which ascribed to its ease of dissection, adjustable thinness, and concealed donor site, as well as the flexible perforator match.