Peroneal Artery Research Articles

Effect of double-leaf perforator free flap posterolateral calf peroneal artery on reconstruction of oropharyngeal anatomy after ablation of advanced oropharyngeal carcinoma

To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma. Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm2. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition). All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation (P < 0.05). The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.

Evaluation of Peripheral Perfusion in the Presence of Plantar Heel Ulcerations Status After Transmetatarsal Amputation With Achilles Tendon Lengthening

The objective of this study is to evaluate peripheral perfusion in patients who developed plantar heel ulcerations status after transmetatarsal amputation and Achilles tendon lengthening. Peripheral perfusion was assessed via contrast angiography of the 3 crural vessels (anterior tibial, posterior tibial, and peroneal arteries), as well as intact heel blush and plantar arch. The secondary objective is to correlate the arterial flow to time to develop heel ulceration and incidence of minor and major lower-extremity amputation. Diagnostic angiography without intervention was performed on 40% of patients (4/10), and interventional angiography was performed on 60% of patients (6/10). In-line flow was present in 0% (0/10) of the peroneal arteries, 60% (6/10) of the anterior tibial arteries, and 70% (7/10) of the posterior tibial arteries. Heel angiographic contrast blush was present in 60% (6/10), and intact plantar arch was present in 60% (6/10). Patients developed heel ulcerations at a mean time of 7.6 months (range 0.7 to 41.2) postoperatively. The incidence of major lower-extremity amputation was 30% (3/10), with a mean time of 5.2 months (range 3.5 to 8.3) from time of heel wound development. No amputation occurred in 6 patients (60%). Among them, intact anterior tibial inline arterial flow was present in 3, intact posterior tibial inline arterial flow was present in 6, and heel blush was present in 5. Our results demonstrate that an open calcaneal branch of the posterior tibial artery is sufficient to heal plantar heel ulcerations to potentially increase rates of limb salvage.

Achieving a Normal Perfusion State From Peroneal Bypass Impacts Limb Outcomes for Patients With Tissue Loss But Not Rest Pain

The peroneal artery is a well-established but indirect bypass target for treating chronic limb-threatening ischemia (CLTI). Attaining normal/near-normal foot perfusion after peroneal bypass remains possible with robust collateral flow. Here we evaluate the long-term limb outcomes of achieving optimal versus suboptimal foot perfusion after peroneal bypass in patients with CLTI.

The vascularization of the peroneal tendons: An anatomic study

BackgroundArterial vascularization is intimately related to the peroneal tendon ruptures. Our purpose is to describe the vascular anatomy of peroneal tendons and assess differences in the vascularization patterns between peroneus brevis tendon (PBT) and peroneus longus tendon (PLT). MethodsAnatomical study of 22 cadaveric lower extremities. We exposed tendons’ vascularization by injecting latex. To systematize the vascular description, we considered four anatomical regions in the PBT and six in the PLT. ResultsVascularization was supplied by the peroneal, anterior tibial and lateral plantar arteries and from the deep plantar arch through the vincula connecting the tendons. No avascular areas were found in the PLT. 22.7% of specimens had avascular areas in the PBT. Two visual vascularization patterns were found (arcuate and weblike). Increasing age and a web-like vascularization were associated with a lower number of blood vessels at the tendons’ post malleolus area. ConclusionPeroneal tendons are well vascularized throughout their course, running through a common vincula, with vascularization provided by various arteries. Avascular areas were observed in the PBT, but none at the PLT.

Anatomical study of perforators of posterior upper and middle third of leg to assess feasibility of combined gastrocnemius flaps

A common problem seen in the plastic surgery referrals for management of fractures of the leg is the loss of tissue cover over the tibia. This is probably due to the fact that the anterior border of tibia is subcutaneous and prone to loss of tissue following road traffic accidents. To solve this problem a large amount of tissue is required which is mostly available on the posterior aspect of the leg. In order to move this tissue without risk of necrosis the flap must be supplied by an adequate number of perforator vessels. Therefore we decided to study the anatomy of perforators of the sural artery along with the posterior tibial and peroneal system so that the anatomical basis of a combined flap may be defined. : We performed cadaveric dissection in 20 legs to note the location of the proximal and distal most perforators arising from the sural, peroneal and posterior tibial arteries on the posterior aspect of the leg extending from the intercondylar line up to 8cm proximal to the medial an lateral malleolus. The area of medial belly of gastrocnemius with the adjacent posterior tibial perforators was designated as the medial flap and the area over lateral belly of gastrocnemius with adjacent peroneal perforators was designated as lateral flap. In the area defined as the medial flap we found an average of 2.5 perforators arising from the medial sural artery and 1.7 arising from the posterior tibial artery. In the medial flap the distal most perforator was the posterior tibial septocutaneous perforator, which was at an average 23.3cm from the intercondylar line, around 6.8 cm farther away from the distal most medial sural perforator. In the lateral flap region we found an average of 1.7 lateral sural perforators along with 1.5 peroneal perforators. In this flap the distal most perforator was the peroneal septocutaneous, at an average distance of 23.1cm distal to the intercondylar line and at an average of 7.3cm further away from the distal most lateral sural perforator. On examination of the anatomical basis of the combined medial and lateral flap it is possible to raise long flaps of around 25-30 cm, which would be ideal to resurface long defects on the anterior aspect of leg. Raising these flaps with the gastrocnemius muscle in the flap would help to increase the axis of rotation of the flap allowing the flap to move to the anterior aspect of leg and even for resurfacing large defects over the knee

Anatomical features of the extensor digitorum brevis muscle as a plastic material in reconstructive surgery of facial paralysis

Relevance. Facial paralysis is a common neurological illnesses of the maxillofacial region. Gold standard of dynamic correction of permanent facial paralysis is gracilis muscle transfer. However, using this flap is impractical or impossible in some cases. There are few domestic and international publications about extensor digitorum brevis muscle for facial reanimation surgery.Purpose. Assessment of muscle variability on the dorsum of the foot; analysis of blood supply and innervation of the extensor digitorum brevis muscle.Materials and methods. Operations performed on 10 unclaimed corpses: dissection of the extensor digitorum brevis muscle, as well as the blood vessels and nerves of the dorsum of the foot. The legal and ethical requirements for such studies were observed planning the design of the study and during work.Results. As a result, in 80% of cases, was found a typical anatomy of muscles, blood vessels, and nerves in the dorsum of the foot. In 10% was found a typical anatomy of muscles and nerves, but there was no lateral tarsal artery – the branch of the dorsal artery of the foot. Blood supply to the extensor digitorum brevis muscle performed by perforating branches of the peroneal artery. In 10% was found subtotal atrophy and fibrous degeneration of the extensor digitorum brevis muscle.Conclusions. The use of the extensor digitorum brevis muscle is a perspective method for the treatment of facial paralysis. Harvesting of this flap is complicated.

Posterior to anterior malleolar extended lateral approach to the ankle (PAMELA): a cadaveric anatomic study.

The posterolateral approach is used in most cases of surgical treatment of ankle fractures involving the posterior and lateral malleoli. However, this approach does not allow access to the anterolateral structures of the ankle, which represent important landmarks to allow an anatomical reduction in case of complex ankle fracture. Our objective is to propose a novel surgical approach for optimal management of injuries including both a fracture of the posterior malleolus and a complex lesion of the lateral and/or anterolateral portions of the ankle. Cadaveric dissection, including a vascular study, was performed on eight specimens. Assessment included density of the vascular supply around the lateral malleolus, identification of the structures at risk, quality of exposure of the bony structures, and convenience of hardware fixation. The cutaneous flap benefits from a rich interconnected arterial supply. Structures at risk, including the superficial peroneal and sural nerves, the lesser saphenous vein, and the peroneal artery are easily identified and protected. The interval between the peroneal tendons and the flexor hallucis longus muscle provides optimal access to the posterior malleolus. The lateral malleolus is exposed by retracting the peroneal tendons medially. An anterolateral arthrotomy, respecting the anterior talofibular and tibiofibular ligaments, offers a sharp view on the talo-tibio-fibular junction. Hardware placement can be done with optimal access to any exposed surfaces. The PAMELA opens a new perspective in the optimal management of complex fractures of the ankle. The approach allows optimal exposure to address fractures of the posterior malleolus, of the lateral malleolus, and of the anterolateral portion of the ankle through a single incision. Application in clinical practice is the subject of a future study in our institution.

Popliteal Artery Branching Variations: A Study on Multidetector CT Angiography

Determining the branching pattern of the popliteal artery (PA) is an important step in planning some radiological and surgical procedures. The aim of this study was to investigate the course and morphology of the terminal branches of the popliteal artery using multidetector computed tomography (MDCT) angiography, and also to determine possible role gender in branching pattern. Three-hundred forty lower extremity MDCT angiography images for 170 patients (118 M, 52 F), who were between 20–80 years old, were examined. Popliteal artery branching types were grouped as percentage incidences. TPT diameters and lengths in Type IA extremities were compared based on gender and right or left side. Anterior tibial artery (ATA), posterior tibial artery (PTA) and peroneal artery dominance rates were calculated. 5000 times measurement data was mixed so that the cascade mean filter values were calculated for the right and left TPT length each time. It was observed that Type IA was the most common branching pattern (89.4%). The variational pattern incidence was 10.6% and the most common category was Type III (4.1%). The most common pattern was Type IB (3.2%). Variational pattern was 2 times more prevalent in females when compared to the males. The mean TPT diameter was 4.5 mm (2.7–7.3 mm) and there was no difference based on gender and the right-left side. The most common dominant artery for the right and left legs was PTA in both genders. The cut-off values calculated for the right and left TPT independent of gender were 31.30 ± 2.40 and 28.36 ± 2.58, respectively. Three new subtypes were identified as short (S ≤ 2 cm), standard (N = 2–4 cm) and long (L ≥ 4 cm) in Type IA, since it is in a wide variational range although it is a typical PA branching pattern.

Heparin-induced thrombocytopaenia following abdominal aortic aneurysm repair complicated by treatment failure of rivaroxaban

Heparin-induced thrombocytopaenia (HIT) is a rare life-threatening complication following exposure to heparin. It is mediated by immune-mediated thrombocytopaenia due to antibody against heparin platelet factor 4 complex. Early identification of the condition and the prompt administration of appropriate treatment are important to prevent morbidity and mortality from HIT. We report a case of HIT associated with open abdominal aortic aneurysm repair causing anterior tibial artery and peroneal artery thrombosis following prophylactic use of unfractionated heparin for prophylaxis of venous thromboembolism. Even though enoxaparin was switched to rivaroxaban after HIT was suspected, our patient unfortunately developed a minor cerebrovascular accident during the hospital stay as a consequence of HIT.

Human cadaveric Study of Soleus Muscle arterial blood supply and its Application in peri-ankle Reconstruction

Introduction: Soft tissue defects of the lower limb are a formidable challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Aim of the work: study the anatomy of the various patterns of arterial supply to soleus muscle based on cadaveric dissection for its application as a pedicle flap for lower leg and peri-ankle reconstruction. Methodology: The study included 8 adult lower limbs from the Department of Anatomy at Faculty of medicine Al-Azhar University. The study duration was from May 2018 to May 2019. The branches of popliteal, posterior tibial and peroneal arteries were traced till their point of entry into the soleus muscle.These were considered as extra muscular branches(EMB) to the soleus. Results: Popliteal artery supplies the muscle by 1 perforator at 2 samples , 2 perforator branches at 3 samples and absent at 3 samples .Posterior tibial artery: supplies the muscle by not less than 4 perforators at 8 samples. Peroneal artery: supplies the Soleus muscle by 2 to 4 perforators according to our study 2 samples were supplied by 2 perforators , 4 samples were supplied by 3 perforators and 2 samples were supplied by 4 perforators Conclusion: The proximal 25 % of length of soleus received EMB from all the three arteries and hence a proximally based soleus muscle flap is better than distally based muscle flap. Recommendations: Doppler ultrasonography and angiography are useful for detection the actual location and size of soleus perforators.

Distally Based Sural Adipofascial Turnover Flap for Coverage of Complicated Wound in the Foot and Ankle Region.

Distally based perforator propeller flap from the lower leg region is a versatile local reconstructive technique for the foot and ankle defects. However, flap venous congestion remains a tough nut to crack. We hypothesize that raising an adipofascial flap with turnover mode of transposition can improve venous drainage and enhance flap safety. Based on the 2 rows of septocutaneous perforators in the posterior distal third of the lower leg, distally based adipofascial flap was raised from medial sural region nourished by 1 perforator bundle from the posterior tibial artery or from the lateral sural region from the peroneal artery. The superficial dissection was performed in subdermal plane and deep in to the subfascial space. The flap was nourished by perforator-plus-adipofascial pedicle and turned over 180 degrees upside down to reach the distal wounds. One week later, a split-skin graft was used to cover the exposed fascial flap. Postoperatively, flap survival, complications, and patient functional recovery were evaluated. Distally based sural turnover adipofascial flaps were used in 12 cases with complicated wounds of the distal third lower leg, foot, and ankle region. All wounds were caused by trauma and experienced fracture implants fixation and 5 with osteomyelitis. The comorbidities include diabetes in 9 cases and smoking in 7. There were 8 medial ural flaps and 4 lateral sural flaps. The adipofiscial flaps measured from 6.0 cm × 5.0 cm to 17.0 cm × 6.0 cm (mean, 61.3 cm). Postoperatively, all flaps survived uneventfully without any complication such as flap ischemia and/or necrosis. Two minor donor site complications were encountered, one was postoperative hematoma, and another was hyperproliferative scar. After a mean of 14.6 months of follow-up, the adipofascial flap plus skin graft showed a durable esthetic coverage, with normal shoe wearing and walking. Distally based sural adipofascial turnover flap is a simple and reliable wound coverage technique. It avoids venous congestion as usually seen in distally based fasciocutaneous flaps.

Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap

To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap. Between March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained. The origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements ( P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%. The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.

Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction

Introduction Reverse neurocutaneous and propeller perforator flaps are both used to reconstruct diabetic distal lower limb defects. Our study aims to compare outcomes between these two groups of flaps with an emphasis on indications and complication rates.Method A retrospective analysis was conducted, reviewing data from 54 diabetic patients who underwent reconstruction of acute or chronic wounds of the foot and ankle between 2005-2018. Thirty-four patients (Group A) had a reverse neurocutaneous flap (NCF): nineteen sural and fifteen lateral supramalleolar flaps. Twenty patients (Group B) had a propeller flap (PF) based on peroneal (n = 13) or posterior tibial artery perforators (n = 7). All patients had a preoperative Doppler examination to identify the nutrient artery of the flap. In both groups, we recorded patients’ demographics, characteristics of the defect, postoperative complications and time to heal. Follow-up ranged from 6 to 59 months. Student's t-test and chi-squared test were used for statistical analysis.Results Mean patients’ age was 59.1 and 50.8 years for Group A and B, respectively. Defects were located at the Achilles zone (n = 16), posterior heel (n = 14), foot dorsum (n = 9), lateral and medial malleolar areas (n = 8), anterior ankle (n = 5) and lateral foot (n = 2). Mean size of the defect was 42.8 cm2 in Group A and 23 cm2 in Group B. Uneventful healing was recorded in 20/34 neurocutaneous flaps and in 12/20 propeller flaps; complications included two complete flap losses (one NCF, one PF), seventeen distal flap necroses (10 NCFs, 7 PFs), fifteen delayed wound healing events over the donor or recipient site (12 NCFs, 3 PFs). Secondary surgeries were required in 15 NCF and 8 PF patients. Mean healing time was 48.1 and 40.7 days for Group A and B, respectively. All patients, except one NCF case, which resulted in leg amputation, returned to previous levels of ambulation.Conclusion Reverse neurocutaneous and propeller flaps may provide stable reconstruction of diabetic lower limb defects; neurocutaneous flaps are specially indicated for larger and more distally located defects, although they might be associated with longer healing time and additional revision surgeries. Propeller flaps were more frequently used in younger patients for smaller and more proximally located defects.

Congenital fibular dystrophisms conform to embryonic arterial dysgenesis.

The congenital short limb (CSL) with fibular deficiency has traditionally been graded by plain radiography. The most popular orthopedic classification sorts the fibular dysmorphologies into three radiographic groupings: IA (thinned), IB (proximally truncated), or II (absent). In contrast, the soft tissues have been relatively neglected. Since bone formation of the fibula progresses from the anlage, a scaffolding cartilage mold intermediate, cartilage transformation to bone is dependent upon timely embryonic arterial invasion. Absences of the requisite arteries predicate specific skeletal dysmorphologies. The usual arterial supply of the fibula is comprised primarily of the anterior tibialis artery (ATA), which uniquely supplies the proximal portion of the fibula, and also joins the peroneal artery (PA) in supplying the mid to distal fibular shaft. Combinations of the two nutrient arteries allow four potential variations of fibular vascular supply, among which the ATA and PA conjoin to supply the normal fibula and variably supply the three dysmorphic fibular models. The IA and IB deformities conform, respectively, to the absences of the PA and the ATA. Combined ATA and PA absences present in the radiographically "absent" fibula. Thus, each of the four fibular (dys)morphologies conforms to a specific embryonic pattern of arterial development. The term "dystrophism" most accurately characterizes such malformed long bones.

A study on perforating peroneal artery

Aims. Peroneal flap with vascular pedicles is considered as a good substitute for limb reconstructions or any other soft tissue defects because of the number of perforating branches given from the PA. Purpose of this study is to evaluate the branching and communicating pattern of distal most perforating peroneal artery (PP). Methods. Dissected lower limbs of 48 cadavers were studied for the course and communications of PP. Results. The study encountered usual as well as variant communications of PP. In about 12% of the study sample PP continued as DPA and in about 6% of the cases it was communicated with DPA dorsal to the talar head region. The most frequent finding in the present study is PP piercing the interosseous membrane between tibia and fibula at about 6 to 6.5cm proximal to the tip of lateral malleolus. In one of the specimens it was piercing the LM at the base of LM. Conclusions. The results of present study imply a cautious dissection to locate an appropriate vascular pedicle for the flap surgery as there are small communications of PP with ATA as well as DPA and PP can also take variant course. Because failure to do so may lead to accidental and serious vascular injuries.

Outcome and Distal Access Patency in Subintimal Arterial Flossing with Antegrade-Retrograde Intervention for Chronic Total Occlusions in Lower Extremity Critical Limb Ischemia

PurposeTo report the outcome and distal access patency of the Subintimal Arterial Flossing with Antegrade-Retrograde Intervention (SAFARI) technique for chronic total occlusion (CTO) in critical limb ischemia (CLI). Materials and MethodsFrom January 2009 to June 2015, 220 SAFARI procedures were performed for 200 limbs in 191 patients (108 males [56.5%]; median age, 70 years old; range, 36 to 97 years old) with CLI (9.4% were Fontaine classification 3; and 90.6% were Fontaine classification 4). Distal access was obtained from the distal superficial femoral artery (n = 6), popliteal artery (n = 49), anterior tibial artery (n = 56), dorsalis pedis (n = 51), peroneal artery (n = 12), posterior tibial artery (n = 45), and lateral plantar artery (n = 1). Distal access hemostasis was obtained with internal balloon tamponade in 71.4% (n = 157). Outcome measurements were technical success, freedom from major amputation and complications. Preprocedural angiograms of clinically driven repeat interventions were reviewed in 73 cases for distal access patency. ResultsTechnical success was achieved in 80.5% (n = 177). Reasons for technical failure include inability to obtain distal access (n = 3), cross the occlusion retrogradely (n = 16), re-enter the true lumen (n = 9), and achieve antegrade blood flow after the procedure (n = 15). Freedom from major amputation for technically successful procedures was 84.7%, 82.9%, and 81.9% at 6, 12, and 24 months, respectively. There were 3 cases of distal access bleeding with 1case that required coil embolization. The distal access remained patent in 80.8% of observable cases with repeated endovascular intervention. ConclusionsDistal retrograde arterial access (SAFARI) technique is safe and effective in the treatment of CTOs in the context of CLI, after failure of antegrade revascularization.

Study on the relationship between the extent of runoff lesions under the knee and the patency of femoropopliteal artery stent in patients with diabetes

Objective To evaluate the impact of runoff score on the patency of femoropopliteal artery (FPA) stent in patients with type 2 diabetes mellitus with ultrasonography. Methods A retrospective review of a database of 127 patients with type 2 diabetes mellitus (127 limbs) undergoing femoropopliteal stents in Xuanwu Hospital from January 2016 to July 2018 was made. Demographic characteristics and possible related risk factors were recorded. The extent of FPA disease and the runoff lesions below the knee (anterior tibial artery, posterior tibial artery, and peroneal artery) were preoperative evaluated and regular followed-up by color Doppler ultrasonography (CDU). Femoropopliteal artery lesions were graded according to the Trans-Atlantic Inter-Society Consensus (TASCII), and the runoff lesions below the knee were scored according to the Society for Vascular Surgery (SVS). The patency and the predictors for in-stent restenosis were assessed using a Kaplan-Meier and Cox proportional hazards model. Results Follow up period ranged from 1 month to 24 months.The total patency rates at the 3, 6, 12, 24 months were 91.5%, 70.9%, 45.7% and 31.7%, respectively. Post-procedural runoff score according to SVS criteria: 1-3 scores in 45 limbs, 3.5-5 scores in 37 limbs, 5.5-7 scores in 34 limbs, 7.5-10 scores in 11 limbs. The median runoff score was 4.Patients were stratified according to runoff scores (score ≤4 and >4 groups), and the difference of the patency rates between the two groups was statistically significant by Kaplan-Meier analysis and Log-rank test (χ2=10.825, P=0.001). The runoff score affected patency significantly on COX analysis (RR=1.155, P=0.006, 95%CI: 1.042-1.281). Conclusions Compromised runoff negatively affects the patency of FPA stent. High post-procedural runoff score is a main risk factor related to loss of patency. CDU is a reliable method for monitoring patients with femoropopliteal stenting. Key words: Ultrasonography; Diabetes; Femoropopliteal artery; Runoff score; Stent

Clinical application of island flap with a pedicle of the descending branch of perforating branch from lateral anterior malleolus of peroneal artery in repairing midfoot and forefoot soft tissue defects

Objective To explore clinical application of the island flap pedicled of the descending branch of perforating branch from lateral anterior malleolus of peroneal artery in repairing the soft tissue defects in midfoot and forefoot. Methods From January, 2010 to December, 2016, based on the anastomosis between the descending branch from a terminal branch of peroneal artery on the anterior aspect of the lateral malleolus and other branches located around the ankle joint and sinus tarsi, island flap with a pedicle could be harvested more distally and to be used in covering the soft tissue defects in midfoot and forefoot of 5 patients. Sizes of the flap were from 15 cm×12 cm to 8 cm×6 cm. All patients were followed-up in outpatient clinic or through WeChat. The appearance of the flaps and ankle function were recorded simultaneously. Results All flaps were survived without any secondary surgeries. During the follow-up of 6-15 months, the texture of flaps was good with satisfactory estheticity. Range of motion at the injured ankle was 15° in dorsi flexion and 25° in plantar flexion. Conclusion The flap with a pedicle of the descending branch of perforating branch from lateral anterior malleolus of peroneal artery is good enough to be used in the reconstruction of soft tissue defects in midfoot and forefoot. Key words: Peroneal artery; Terminal perforating branch; Island flap; Microsurgical technique

Pedicled perforator flaps for mid-tibial soft tissue reconstruction in medically compromised patients

BackgroundThe soft tissue of the central pretibial area is difficult to reconstruct often requiring free tissue transfer. Especially medically compromised patients are not ideal candidates for free tissue transfer and may benefit from expeditiously harvested local flaps with limited donor site morbidity. As muscle flaps are rare, pedicled flaps based on lateral perforators represent an alternative as the arc of rotation can often be limited to 90°. Material and MethodsA retrospective analysis of patient data was conducted to identify patients over the age of 60 years with comorbidities that underwent pretibial soft tissue reconstruction with a single-pedicle perforator flap. Patient demographics, size and cause of the defect, flap dimension, arc of rotation and complications were recorded. ResultsFive patients with an average age of 71.4 years were included. The arc of rotation was 69°, all flaps healed. There were two recurrences of osteomyelitis. ConclusionLateral perforators originating from the anterior tibial artery or peroneal artery are adequate source vessels for single pedicled perforator flaps even in medically compromised patients. A perforator located proximal to the defect allows limiting the arc of rotation to less than 90°, which increases the safety of the flap. Patients benefit from a simple procedure without a microvascular anastomosis and a donor site confined to one extremity.

3:18 PM Abstract No. 310 Outcomes of infrapopliteal stenting for critical limb ischemia

To evaluate outcomes of infrapopliteal artery stenting including target lesion revascularization (TLR), patency, and subsequent major adverse limb events (MALE) in the setting of critical limb ischemia (CLI). A retrospective single-center review was performed of patients undergoing stenting for early restenosis or failed angioplasty within the tibioperoneal trunk, tibial or peroneal arteries for CLI between January 2010 and August 2019 (n = 49 limbs in 43 patients). Patients received at least one or more drug-eluting (n = 48) or bare-metal stents (n = 1). Freedom from TLR was the primary measure defined as any repeat percutaneous intervention of the target lesion. Other measures included primary and secondary patency, defined with ultrasound Doppler showing peak systolic velocity ratio >2.0 or confirmed angiographically. Limb salvage was defined as freedom from major amputation at or above the ankle. Freedom from MALE was composite freedom from TLR, primary patency, and major amputation. Patient demographics were mean age 70 ± 12 years (SD) with 67% men, 90% hypertension, 56% dyslipidemia, 54% diabetes, 27% ESRD, 45% smoking history and 100% CLI. Mean follow-up time was 10.3 months (range, 0-52); 9 patients underwent TLR (18% limbs). Kaplan-Meier analysis at 12-months for freedom from TLR, primary patency, and freedom from MALE (±SE) were 80 ± 7.1%, 67 ± 10.3%, and 60 ± 8.7%, respectively. Overall limb salvage rate was 71% (35/49) with 2 of the major amputations occurring beyond 12 months from index procedure. No major procedural complications occurred. One stent fracture with occlusion was observed. 1 patient had a non-fatal myocardial infarction and 1 patient had a stroke; 7 other patients died during follow-up, with 2 PAD-related deaths at 1 and 12 months. Other deaths were from cardiac, pulmonary embolus, pancreatic cancer, pneumonia, and one unknown cause 4-33 months post stenting. Stenting in the infrapopliteal arteries had high rates of freedom from target vessel revascularization and limb salvage. Further studies involving long-term outcomes and safety profiles are needed for currently used stents within the infrapopliteal vasculature.