Free Posterior Tibial Artery Perforator Research Articles

Clinical comparative study of free posterior tibial artery perforator flap and radial forearm free flap for head and neck reconstruction

Objective: To compare the clinical application results of the FPTF (free posterior tibial artery perforator flap) and RFFF (radial forearm free flap) for reconstruction of head and neck defects. Methods: A retrospective analysis of 27 cases treated with FPTF (19 males and 8 females, aged 14-69 years) and 24 cases with RFFF (11 males and 13 females, aged 22-69 years) for head and neck defect reconstruction at Beijing Tongren Hospital of Capital Medical University from January 2015 to December 2020 was conducted. Flap size, vascular pedicle length, matching degree of recipient area blood vessels, preparation time, total operation time, hospital stay, recipient area complications, donor area complications and scale-based patient satisfaction were compared between two groups of patients with FTPF and RFFF. SPSS 26.0 statistical software was used for statistical analysis. Results: There was no statistically significant difference between the two groups of patients in tumor T staging (P=0.38), primary sites (P=0.05) and mean flap areas ((53.67±29.84) cm2 vs. (41.13±11.08) cm2, t=-1.472, P=0.14). However the mean vascular pedicle length of FPTF was more than that of RFFF ((11.15±2.48)cm vs. (8.50±1.69)cm, t=-4.071, P<0.01). The donor sites of 4 patients in FPTF group could be sutured directly, while all the 24 patients in RFFF group received skin grafts from the donor sites. There was no statistically significant difference in the recipient area arteries between two groups of flaps (P=0.10), with more commonly using of the facial artery (RFFF: FPTF=21∶27), but there was significant difference in the recipient area veins (P<0.01), with more commonly using of the external jugular vein in RFFF (14/24) than FPTF (4/32) and the posterior facial vein in FPTF (27/32) than RFFF (9/24). There were 10 recipient complications and 3 donor complications in RFFF group; no recipient complication and 3 donor complications occurred in FPTF group. With patient's subjective evaluation of the donor site at 12 months after surgery, FPTF was better than RFFF (χ²=22.241, P<0.01). Conclusions: FPTF is an alternative to RFFF in head and neck reconstruction and has unique advantages in aesthetics and clinical application.

Anatomic basis and clinical application of perforator flap thinning of posterior tibial artery

Objective To explore the anatomic basis of the thinning of the free posterior tibial artery perforator flaps and the clinical effect of repairing wound on hand or foot due to trauma. Methods From November, 2016 to December, 2017, 10 cases of lower extremity cadaver specimens perfused with red ralex were dissected, which were perfused through the amputated femoral artery. Five of them were left and the rest were right. All cases were males. The number, diameter, branches and distribution of the perforator was observed. From September, 2012 to September, 2017, there were 13 cases of clinical application, which were 5 cases of hand wound and 8 cases of foot wound. The size of the wound was 3.0 cm × 2.0 cm to 6.0 cm × 4.0 cm, and the flap area was 3.5 cm × 2.2 cm to 6.5 cm × 4.5 cm. The repairing procedure was suitable for the wound associated with tendon, bone, joint capsule exposure. Results The number of posterior tibial artery perforating branches that more than 0.50 mm in diameter was 4 to 6, and the mean diameter was (0.87±0.26) mm. The perforating branch penetrated into the fat layer and was divided into 3 layers of vascular network: deep fat vascular network, superficial fat vascular network and subdermal vascular network. The perforating branch was located according to the positional relationship from deep to shallow, and vessel diameter become smaller step by step. The perforating branch trunk gave off branches to the deep vascular network, and the superficial vascular network had the same origin or shared with the deep blood vessels. The subdermal vascular network issued from the superficial vascular network or directly from the perforating branch trunk. There was no or few communicating branch between the deep vascular network and superficial ones, besides the vessel pedicle. So trimming deep fat layer will not affect the blood supply of superficial vascular network and neither will affect the flap blood supply. Most of the deep fat tissue was trimmed in 13 cases. The superficial and subdermal fat vascular network was preserved, and the same to the trunk and branches of the pedicle. All the flaps survived. Of which, 1 appeared arterial crisis on the 2nd day after operation, and relieved by the local injection of papaverine. There was 1 case of venous crisis on the 3rd day, and improved by stitches, local release of congestion. Followed-up time was ranged from 2 to 12 months. All flaps were soft with good blood supply and good appearance, and did not need a second thinning surgery. Flaps restored the protective feeling 6 months later. Conclusion The microdissection of perforator flap of posterior tibial artery provides a theoretical basis for the perforator flap thinning, and the thinning of perforator flap is a good method to repair the appearance and function of the wound after foot and hand injuries. Key words: Posterior tibial artery perforator flap; Applied anatomy; Wound; Repair; Microsurgical operation

Free posterior tibial artery perforator flap for 2-stage tracheal reconstruction in patients after resection of well-differentiated thyroid carcinoma invading the trachea.

BackgroundThe present study was conducted to explore the efficacy of using a free posterior tibial artery perforator flap (FPTAPF) for trachea reconstruction after resection of well‐differentiated thyroid carcinoma (WDTC) invading the trachea.MethodsWe retrospectively collected and analyzed clinical and surgical data from 14 patients who underwent tracheal reconstruction using a FPTAPF after resection of WDTC invading the trachea between August 2014 and July 2017.ResultsSatisfactory tracheal structure and functional recovery were obtained in 11 of the 14 patients. One patient had breathing difficulties after tracheostomy closure tests because of bilateral recurrent laryngeal nerve damage caused by disease invasion. Tracheostomy incision was not closed in 2 patients because they received postoperative adjuvant radioactive iodine 131 treatment.ConclusionSatisfactory tracheal reconstruction results were achieved in patients with resection of WDTC invading the trachea, indicating that a FPTAPF is a safe and reliable choice for management.

Free posterior tibial artery perforator flap for floor of mouth reconstruction: A case report

In this report, we present a case with floor of mouth squamous cell carcinoma who underwent wide excision of tumor, a marginal mandibulectomy and bilateral selective neck dissections. A 7 cm × 4 cm fasciocutaneous flap based on a posterior tibial artery perforator (PTAP) from the left posterior leg was harvested to reconstruct a floor of the mouth defect. The donor-site defect was closed primarily. The flap survived in its entirety. No donor or recipient site complications occurred. The patient tolerated a regular diet at 3-month follow-up with normal speech and leg function. To our knowledge, there has been no previous report on the use of the PTAP flap for floor of mouth reconstruction. Our experience has shown the PTAP flap could be one of options for small defects.