Plantar Artery Research Articles

Dynamic Ultrasound Assessment and Guided Medial Plantar Nerve Hydrodissection for Master Knot of Henry Syndrome.

A 27-year-old female presented with persistent right medial plantar pain that developed over six months following an ankle sprain. The pain, described as sharp and radiating to the toes, progressively worsened, affecting her ability to walk. An initial ultrasound examination suggested medial plantar nerve compression by a lipoma, prompting her referral for ultrasound-guided hydrodissection. During the pre-procedure assessment, sono-palpation (palpation using the ultrasound transducer) localized the pain to the Master Knot of Henry-where the medial plantar nerve, artery, and flexor tendons intersect. No lipoma but a normal fat pad was observed. Ultrasound-guided hydrodissection with 5% dextrose mixed with lidocaine and saline was performed. After two sessions, her pain significantly decreased, with her visual analogue scale score dropping from 8 to 5 after the first session and to 2 after the second, allowing her to resume normal activities. This case highlights the value of ultrasound in accurately diagnosing and treating conditions involving the Master Knot of Henry.

Fillet of toe flap coverage for non-traumatic foot amputations: A retrospective review of 70 patients

Fillet of toe flap (FTF) leverages the “spare parts” algorithm in reconstructive surgery–utilizing tissue from amputated or otherwise non-salvageable body parts, thus avoiding donor-site morbidity. This study assesses the efficacy of FTF coverage in non-traumatic foot amputations. A retrospective review of patients undergoing foot amputation with FTF coverage between January 2013 to August 2023 was conducted. Patient characteristics, operative details, and outcomes were collected. Primary outcome was FTF survival (no necrosis ≤7 days postoperatively). Secondary outcome was acute complications (≤42 days postoperatively). A total of 70 patients were included. Mean age was 65.0±13.7 years. Median Charlson Comorbidity Index was 6.0 (interquartile range [IQR]: 4.0-7.0). The most common wound location was the hallux (n=34). In 45 (64.2 %) patients with preoperative angiography, the patency rates were: first dorsal metatarsal artery (n=10, 22.2 %), lateral plantar artery (n=7, 15.6 %), medial plantar artery (n=6, 13.3 %), and dorsalis pedis artery (n=4, 8.9 %). Mean follow-up duration was 9.0 (IQR: 32) months. Fifteen (21.4 %) patients experienced at least one acute complication: deep surgical site infection (SSI; i.e., abscess, gangrenous necrosis; n=13, 18.6 %) and cellulitis (n=7, 10.0 %). Eleven (15.7 %) patients required reoperation for debridement (n=4, 5.7 %), wound closure (n=4, 5.7 %), flap necrosis (n=3, 4.3 %), incision and drainage (n=1, 1.4 %), split-thickness skin grafting (n=1, 1.4 %), and foreign body exploration (n=1, 1.4 %). FTF survival was 94.2 % (n=66). FTF facilitates reconstruction in complex cases and should be integrated into each chronic LE wound algorithm to avoid additional donor-site morbidity, and to facilitate stump-length preservation or limb salvage.

Single-stage Hallux Reconstruction with Free Wraparound Medial Plantar Artery Flap with Iliac Bone Graft: A Case Report

Single-stage Hallux Reconstruction with Free Wraparound Medial Plantar Artery Flap with Iliac Bone Graft: A Case Report

PLANTAR STRUCTURES IN RELATION TO A STRAIGHT RETROGRADE HIND FOOT (RHF) NAIL INSERTED THROUGH A MIDLINE HEEL PAD APPROACH: A CADAVERIC STUDY

BackgroundRHF nail is an important tool for simultaneous ankle and subtalar joint stabilisation +/− fusion. Straight and curved RHF nails are available to use, but both seem to endanger plantar structures, especially the lateral plantar artery and nerve and Baxter's nerve.There is a paucity of literature on the structures at risk with a straight RHF nail inserted along a line bisecting the heel pad and the second toe (after Stephenson et al). In this study, plantar structures ‘at risk’ were studied in relation to a straight nail inserted as above.MethodsRe-creating real-life conditions and strictly following the recommended surgical technique with regards to the incision and guide-wire placement, we inserted an Orthosolutions Oxbridge nail into the tibia across the ankle and subtalar joints in 6 cadaveric specimens. Tissue flaps were then raised to expose the heel plantar structures and studied their relation to the inserted nail.ResultsThe medial plantar artery and nerve were always more than 10mm away from the medial edge of the nail, while the Baxter nerve was a mean 14mm behind. The lateral plantar nerve was a mean 7mm medial to the nail, while the artery was a mean 2.3mm away with macroscopic injury in one specimen. The other structures ‘at risk’ were the plantar fascia and small foot muscles.ConclusionLateral plantar artery and nerve are the most vulnerable structures during straight RHF nailing. The risk to heel plantar structures could be mitigated by making incisions longer, blunt dissection down to bone, meticulous retraction of soft tissues and placement of the protection sleeve down to bone to prevent the entrapment of plantar structures during guide-wire placement, reaming and nail insertion.

CT reconstruction based 3D model of the digital cushion's blood supply in the hind foot of an African savanna elephant (Loxodonta africana).

Foot health is crucial for elephants, as pathological lesions of the feet are a leading cause of euthanasia in captive elephants, which are endangered species. Proper treatment of the feet, particularly in conditions affecting the digits and the digital cushion, requires a thorough understanding of the underlying anatomy. However, only limited literature exists due to the small population and the epidemiological foot diseases which often precludes many deceased elephants from scientific study. The aim of this study was to provide a detailed anatomical description of the blood supply to the African elephant's hindfoot. The healthy right hindlimb of a 19-year-old deceased female African savanna elephant was examined using computed tomography. Following a native sequence, 48 mL of barium-based contrast agent was injected into the caudal and cranial tibial arteries, and a subsequent scan was performed. The images were processed with 3D Slicer software. The medial and lateral plantar arteries run in a symmetrical pattern. They each have a dorsal and a plantar branch, which reach the plantar skin before turning toward the axial plane of the sole to reach the digital cushion from the proximal direction. An accurate 3D model of the arteries and the bones of the foot, a set of labeled images and an animation of the blood supply have been created for ease of understanding. In contrast to domestic ungulates, the digital cushion of the hindlimb is supplied differently from that of the forelimb. The lack of large vessels in its deeper layers indicates a slow regeneration time. This novel anatomical information may be useful in the planning of surgical interventions and in emergency medical procedures.

Anatomical Variations of the Medial Plantar Artery Flap: A Cadaveric Study With Clinical Applications

The medial plantar artery flap (MPAF) presents both unique value as well as significant challenges. As the plantar foot has specific anatomy, the use of the MPAF to recreate this highly specialized area may provide improvements in durability and rates of limb salvage. The purpose of this study is to establish the anatomic course of the branching patterns of the medial plantar artery (MPA) and provide a foundation for MPA flap nomenclature as it is related to design and elevation. Thirty-seven fresh frozen cadaver feet were used for dissection: 20 right and 17 left sided limbs. Anatomic measurements recorded included: branching pattern of the MPA, bifurcation distance of the superficial branch (SB) and deep branch (DB) from the origin of the MPA, distance from the MPA origin to the anterior colliculus of the medial malleolus, and the distance from the SB and the DB to the navicular tuberosity. The MPA was found to bifurcate into SB and DB in 30 (81%) specimens; 6 (16%) specimens had only a SB, whereas 1 (3%) specimen had only a DB, which had not been previously described. The distance from the anterior colliculus to the MPA was 3.0 cm, MPA to the distal bifurcation was 2.9 cm, and navicular tuberosity to the SB and DB was 2.2 cm and 1.3 cm, respectively. Minimizing the complexity of the dissection with the use of more reliable landmarks and a deeper understanding of the anatomy may reduce complications and allow for more reproducible outcomes when utilizing the MPAF.

Medial Plantar Artery Flap for Soft Tissue Coverage of Heel Defect: A Case Report

Background: Numerous flap options exist for providing soft tissue coverage for defects on the heel region. This study presents a case where a bone-exposed wound on the left heel region was successfully reconstructed using a medial plantar artery flap. Case Report: A 16-year-old girl presented with a necrotic wound on the left heel region with calcaneus, malleolus, and talus fractures following trans-ankle external fixation on her left leg. After debridement and necrotomy, the wound revealed exposed calcaneus and implant. A medial plantar artery flap was dissected, preserving its vascularization. The flap was then carefully transferred to the wounded area and sutured appropriately. A skin graft harvested from the ipsilateral femoral region was used to cover the donor site. Discussion: This case demonstrates the efficacy of the medial plantar artery flap as a local flap option for heel defect coverage. It is a relatively easy-to-perform procedure that provides a strong and thin skin flap. Moreover, it offers a favorable cosmetic outcome for the patient, as the surgical scar can be be relatively easy to hide with footwear. However, limitations of the medial plantar artery flap include its size and depth constraints, as well as loss of vascularization from a medial plantar artery on the plantar region. Conclusion: The medial plantar artery flap is a feasible option as a local flap for the heel region. It is relatively easy to perform, provides a strong thin skin flap, and can results in a preferable cosmetic outcome.

Microvasculature of the suspensory ligament of the equine hind limb.

To describe the microvascular anatomy of the equine hind limb suspensory ligament. 18 hind limbs harvested from 9 adult horses euthanized for reasons unrelated to lameness. A catheter was placed in the transected cranial tibial artery at the level of the mid-distal tibia for each hind limb and used to inject 120 to 150 mL of contrast medium (2 limbs) to identify principal vasculature using contrast-enhanced CT or India ink (11 limbs) to identify microvasculature using the Spalteholz tissue-clearing technique. Routine histologic evaluation was performed on transverse sections from 4 hind limbs. The hind limb suspensory ligament is principally supplied by branches of the medial and lateral plantar metatarsal arteries and, to a lesser extent, the medial and lateral plantar arteries as well as the associated proximal and distal deep plantar arches. A uniformly distributed intraligamentous microvascular supply was observed without relative deficiencies in vascularity between the proximal, midbody, and distal regions. Histologic examination supported these findings, demonstrating a network of connective tissue surrounding and entering the suspensory ligament containing cross-sections of branches of the principal vasculature. The equine hind limb suspensory ligament has a uniformly distributed and abundant microvascular supply throughout its length, with no evidence of relative deficiency of vascular supply in any region. A region of hypovascularity does not appear to be a viable explanation for the high rate of injury to and commonality of lameness associated with the proximal hind suspensory ligament in horses.

Popliteal-to-Distal Extreme Bypass in Endovascular Era

ObjectivesChronic limb-threatening ischemia (CLTI) is characterized by rest pain and tissue loss, with an annual mortality rate of 20% and amputation rate of 40%, if not treated. Open bypass surgery is recommended in CLTI, depending on the availability of good quality venous material, outflow artery patency and surgical expertise. Aim of the study is to analyze primary patency, limb salvage and survival rate in patient undergoing popliteal-to-distal bypass. MethodsAll consecutive patients who underwent popliteal-to-distal bypass surgery between January 2016 and December 2021 were enrolled in the study. Primary outcomes were primary patency, limb salvage and overall survival. Secondary outcomes included amputation-free survival and secondary patency. ResultsForty-nine patients were included during the study. Technical success was achieved in 100% of cases. Target outflow artery was in 27% (n. 13) of cases the anterior tibial artery in 27% (n. 13) dorsalis pedis, in 2% (n. 1) the peroneal artery, in 30% (n. 15) the retro-malleolar tibial artery, in 10% (n. 5) the medial plantar artery, in 4% (n. 2) the tarsal artery. Two-year primary patency was 85%±5. Secondary patency rates was 86%±3 at two years. The overall survival was 81% ±6 at 2 years, the amputation free survival was 70% ±9, and the limb salvage rate was 81% ±6. ConclusionPopliteal-to-distal bypass require high technical expertise to be performed. When a good autologous vein and adequate outflow artery are present, they can be feasible with good patency rates, and overall survival.

In the Loop: Endovascular Pedal Arch Revascularization

Advanced endovascular techniques are increasingly being utilized to treat patients with peripheral arterial disease and chronic limb threatening ischemia to improve lower extremity arterial perfusion. In diabetic patients pedal arch patency has been associated with improved wound healing, limb salvage and overall survival. Pedal-plantar loop revascularization is a technique that can restore arterial inflow between the dorsal and plantar arteries of the foot. This article will describe the inframallelolar arterial anatomy and focus on imaging, percutaneous endovascular techniques and clinical study outcomes of pedal artery interventions.

Arterial highways of the foot of the American raccoon (Procyon lotor)

The vascular system is one of the integrating systems of the human and animal body. The course and branching of the vessels of various areas of the body follows general patterns. However, the variability of the vascular bed is quite high even within a single species of animal. The lack of data on both the topography and the peculiarities of arterial branching makes it difficult to carry out diagnostic and therapeutic manipulations. In addition, the data obtained during the study significantly enrich the available information on the comparative anatomy of the vascular bed. The purpose of the study is to study the main arterial arteries of the American raccoon foot area, to give them a morphometric characteristic. The research was carried out on 4 corpses of an American raccoon, delivered to the Department of Animal Anatomy of the St. Petersburg State University of Veterinary Medicine from veterinary clinics. Classical methods were chosen as research methods: fine anatomical dissection, morphometry, photographing and vasorentgenography. During the study, it was found that two arterial highways are distinguished on the foot of the American raccoon. The dorsal trunk is represented by the dorsal artery of the foot, the plantar trunk is represented by the middle plantar artery. The dorsal artery of the foot passes into the arc artery – the first anastomosis that unites the vessels of the two highways. The middle plantar artery gives rise to the second and third plantar metatarsal arteries and participates in the formation of a deep plantar arch, which is the second major anastomosis of the foot area. Axial and non-axial finger arteries also form collateral blood flow. Analyzing the obtained morphometric data of arterial highways, it follows to conclude that the plantar surface highways have the largest diameter. Thus, the diameter of the middle plantar artery is 1.72 times higher than the same parameter of the dorsal artery of the foot. The largest total diameter is characteristic of the arteries located in the metatarsal region, the smallest in the area of the metatarsal.

Soft tissue reconstruction of the fingers with free medial plantar artery perforator flap

Soft tissue reconstruction of the fingers with free medial plantar artery perforator flap

Preservation of 1st Metatarsal Head Blood Supply with Minimally Invasive Chevron vs Transverse Osteotomy

Introduction/Purpose: The purpose of this study is to evaluate damage to the first dorsal metatarsal artery, first plantar metatarsal artery, and the superficial branch of the medial plantar artery after different types of minimally invasive osteotomies are performed on cadaveric specimen. Methods: 10 cadaveric feet were injected with methylene blue dye to aid in visualizing the vessels. We then randomly divided the samples into 2 groups of 5. Group A received a chevron osteotomy and group B received a transverse cut osteotomy. We then dissected the specimen and studied the damage to the first metatarsal head vascular plexus and recorded the distance of our cuts from the center of the metatarsal head. We plan to take 6 additional cadaveric feet and inject them with silicone based dye prior to performing osteotomies on these additional specimen; 3 chevron and 3 transverse. We will then dissect these specimen in a similar manner to evaluate for vascular plexus damage. We believe this will improve our scientific process. Results: After careful dissection we did not find major damage to the vascular plexus in any of the specimen. Please note: we will be continuing this project with additional cadaveric specimen and improved dye techniques. Conclusion: We did not find a difference in vascular risk between MIS transverse and chevron osteotomy techniques. If the primary safe zone guidelines are respected and care is taken to avoid common pitfalls, surgeons can confidently choose between the two constructs without accommodating further AVN risk. Gross Dissection Displaying First Dorsal Metatarsal Artery

The effect of hallux valgus on the anatomy of the nerves around the first metatarsal bone.

To identify the variations in the location of the nerves that may be at risk in hallux valgus (HV) surgery, and to reveal whether these nerves are affected by the anatomical changes associated with HV. In the formalin fixed, 46 lower extremities (19 female, 27 male) (9 normal, 14 mild HV, 21 moderate/severe HV), extensor hallucis longus tendon (EHL), deep plantar artery, medial dorsal cutaneous (MDCN), deep fibular (DFN), common plantar digital (CPDN) and proper plantar digital (PPDN) nerves were examined. The branches of MDCN extending to the medial side of foot were recorded in three segments. The positional topography of nerves according to EHL were analyzed on 360° circle and clock models. Sex-related differences observed in some parameters in direct measurements were not found in the clock model comparisons. In advanced HV angles (> 20°), DFN was closer to EHL in the distal part of the metatarsal bone, while there was no difference in the proximal. The intersection of the medial branch of the MDCN with the EHL was more proximal in HV cases than in normal feet. The location of the nerves in the clock pattern did not change in HV. Of the nerve branches reaching the medial side of the foot, 65.2% were in Part I, 71.7% in Part II, and 4.3% in Part III. Sex differences in the distance of the nerves to the EHL disappeared when the size effect of the cross-section of the first metatarsal bone region was eliminated with the clock model. Only in advanced HVA (>20°) (not in mild HV), the DFN being closer to the EHL distally and the intersection of the medial branch of the MDCN with the EHL in HV being more proximal than in normal can be interpreted as specific reflections of HV progress. The variations we revealed in the number of branches reaching the inside of the foot may explain the diversity of neuromas or nerve injuries associated with HV surgery.

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia.

Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle-brachial index (ABI) and toe-brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI (r = -0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77-99], a specificity of 96% [95% CI 92-98], a positive predictive value of 73% [95% CI 56-86], a negative predictive value of 99% [95% CI 97-100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98-1.00]. ATmax also showed promising results to rule out PAD in healthy patients. ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.

Complex Heel Defect: A Comprehensive Study On Combined Regional Flaps For Sensate And Stable Coverage.

BACKGROUND: Heel defect has remained a challenging situation for reconstructive surgeons. In large post traumatic defects, the goal is to provide a sensate and stable soft tissue coverage, especially for the weight-bearing part of the heel. The paucity of local tissue options makes the scenario difficult to deal with. OBJECTIVE: This study is aimed to reconstruct large defect, involving both the weight-bearing and non-weight-bearing part of the heel by combining two regional flaps. METHODS: A retrospective study, comprising of 11 patients from January 2016 to December 2019 with large traumatic heel defects, operated in our setup with combined medial plantar and reverse sural artery flap within 72 hours of injury. Follow up period was 6 months postoperatively. RESULT: All flaps survived well except one reverse sural flap, which was congested and later debrided and 2 had distal edge necrosis which were managed conservatively. All the reverse sural flaps were noted to have lymphedema, but only 3 patients opted for debulking surgery. The functional outcome was excellent, with all the patients being able to walk normally, both barefoot and with footwear. The weight-bearing area was sensate, a clear advantage of utilizing instep skin. CONCLUSION: In our experience, the combined strategy of utilizing local tissue for large heel defects, not only provides a sensate, stable, and reliable coverage but also avoids the lengthy procedure of free tissue transfer that in the end would not be able to give similar results.

Improved small vessel visibility in diabetic foot arteriography using dual-energy CT

To test the feasibility and performance of dual-energy computed tomography (DECT) in foot arteriography of diabetic patients, where contrast medium is largely reduced within the small vessels. A total of 50 diabetic patients were enrolled prospectively, where DECT was acquired immediately after the CT angiography (CTA, group A) of the lower extremity. Two images were derived from the DECT data, one optimal virtual monochromatic image (VMI, group B) and one fusion image (group C), both of which were compared against the CTA image for visualising the foot arteries. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were evaluated. The arterial course and contrast were graded each using a five-point scale. The clarity of small vessel depiction was quantified by comparing the number of plantar metatarsal arteries found in the maximum intensity projection image. The median CNRs and SNRs obtained in group B were approximately 45% and 20% higher than those in groups A and C, respectively (p<0.05). Group B also received higher subjective scores on the posterior tibial artery and the foot arteries (all >3) than groups A and C. The number of visible branches of the plantar metatarsal arteries was found to be substantially higher (p<0.05) in group B (median=6) than in groups A (median=2) and C (median=4). DECT was found to be superior to conventional CTA in foot arteriography, and beyond the lower extremity, it might be a general favourable solution for imaging regions with small vessels and reduced contrast medium.

Evaluation of Feasibility of Medial Plantar Artery Flap With Computed Tomography Angiography in Diabetic Patients: A Pilot Radioanatomic Study.

Background A soft tissue defect resulting from a diabetic heel ulcer can be difficult to address due to limited reconstructive options and unique local area demand. The medial plantar artery flap is ideal for heel defect coverage as it provides a thick glabrous skin with good sensory feedback. The prerequisite of medial plantar artery flap surgery is a patent medial plantar artery, which is a branch of the posterior tibial artery (PTA). Nevertheless, no feasibility study of the medial plantar artery flap in diabetic patients with vascular insufficiency has been reported so far. We conducted a pilot study with the aim of investigating the patency of the medial plantar artery in diabetic patients with suspected peripheral artery disease to determine the vascular feasibility of the medial plantar artery flap in these patients. Material and methods A pilot study was performed at Sultan Ahmad Shah Medical Centre at International Islamic University Malaysia (IIUM). A total of 15 diabetic patients with suspected vascular insufficiencywho had undergone lower limb computed tomography angiography (CTA) from January 2022 to June 2023 were included in this study. All patients were identified via the electronic record system.Lower limb CTA images were retrieved from the Radiology Information System (RIS) and Picture Archiving and Communication System (PACS) and were double-reviewed.Both the posterior tibial artery (PTA) and medial plantar artery (MPA) were assessed for their patency, and the diameter of the lumens was measured if they were patent. Bedside clinical assessments such as palpation of pulses and portable Doppler assessment were evaluated to determine whether they could serve as substitutes for computed tomography angiography (CTA) in assessing the feasibility of medial plantar artery flap using the McNemar test. Results In this study cohort, the medial plantar artery was present in 16 legs and absent in another 14 legs. The largest diameter of the medial plantar artery was 2.5mm (range 0-2.5mm). Palpation of the posterior tibial artery was not optimal for predicting the patency of the medial plantar artery, with a false positive of 21.4% and a false negative of 68.7%. Similarly, a hand-held Doppler assessment of the posterior tibial artery was also ineffective, with a false positive of 64.3% and a false negative of 18.8%. While the medial plantar artery is a continuation of the posterior tibial artery (PTA), PTA patency did not necessarily correlate with medial plantar artery patency. This was demonstrated on CTA assessment, where two legs with absent PTA still have reconstitution, resulting in patency of the medial plantar artery. Additionally, one leg with patent PTA did not have a patent medial plantar artery distally due to calcified vessels. Conclusion This is a first-of-its-kind pilot study attempting to determine the feasibility of medial plantar artery in diabetic patients with vascular insufficiency. The medial plantar artery was present in more than 50% of the investigated lower limbs, paving the way for using the medial plantar artery flap in these patients. Nevertheless, a computed tomography angiogram is essential to determine the patency of the medial plantar artery prior to the flap procedure, as palpation and hand-held Doppler were inadequate to predict the patency of the medial plantar artery in these high-risk patients.

Selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle

Objective: To explore the selection strategy of pedicled axial flaps for repairing high-voltage electric burn wounds in foot and ankle. Methods: The retrospective observational research method was used. From January 2017 to December 2022, 16 patients with skin and soft tissue defects in foot and ankle after high-voltage electric burns were treated in General Hospital of Eastern Theater Command, including 11 cases of unilateral defect and 5 cases of bilateral defect. All patients were male, aged from 25 to 75 years. After thorough debridement, the area of the defect to be repaired with the flap was 5.0 cm×4.0 cm to 12.0 cm×8.0 cm. Before operation, the color Doppler ultrasound, computed tomography angiography, or digital subtraction angiography was used to fully evaluate the degree of vascular injury in the affected limb and to identify the distribution and traffic anastomosis of vascular network. Pedicled axial flaps with reliable blood supply were used to repair the wounds as soon as possible, and the area of flaps ranged from 3.0 cm×2.0 cm to 13.0 cm×8.0 cm. The wound in the donor area of flaps was repaired with split-thickness skin graft from head or medium-thickness skin graft from thigh. The flap repair of wounds in various areas of the ankle and foot was recorded. The postoperative survivals of the flaps and skin grafts were observed after surgery. The postoperative appearance of flaps and walking function of patients were followed up. At the last follow-up, the foot and ankle function was evaluated and rated using the American Association of Foot and Ankle Surgeons Ankle Posterior Foot Scoring System. Results: Two wounds in toe area were repaired with reverse dorsal pedis flaps, 3 wounds in medial ankle area and 2 wounds in heel area were repaired with medial plantar flaps, 2 wounds in anterior plantar area combined with toe area were repaired with reverse medial plantar flaps, 2 wounds in anterior plantar area combined with toe area and 5 wounds in anterior plantar area were repaired with reverse medial pedis flaps, 1 wound in toe area was combined with proper plantar digital artery flap, 1 dorsal pedis wound and 1 lateral malleolus wound were repaired with lateral supramalleolar perforator flaps, and 1 lateral malleolus wound and 1 dorsal pedis wound were repaired with sural neurovascular flap. One flap had venous reflux disorder after surgery and survived after treatment, while the other flaps and skin grafts survived completely after surgery. During the follow-up of 6 to 24 months after operation, the appearance of the flaps was good, and the walking function of patients was normal. At the last follow-up, the functional score of foot and ankle was 76 to 95, which was evaluated as excellent in 11 cases and good in 5 cases. Conclusions: According to the condition of high-voltage electric burn in foot and ankle, early and thorough debridement, preoperative imaging examination to evaluate blood vessels of the affected limb, and selection of pedicled axial flap with reliable blood supply are good methods for wound repair and related functional reconstruction of high-voltage electric burn in foot and ankle.

A Comparative Study between Distally Based Sural Artery Flap and Medial Plantar Artery Flap in Reconstruction of Ankle and Foot Defects

A Comparative Study between Distally Based Sural Artery Flap and Medial Plantar Artery Flap in Reconstruction of Ankle and Foot Defects