Soft Tissue Defects Of Foot Research Articles

Outcome of Delayed Distally Based Sural Flap for Distal Tibial and Foot Defects

Abstract: Background: Lower limb defects can be tricky to repair. We have limited options for reconstruction in the leg and foot region. Sural flap is considered as the workhorse for reconstruction of these defects. We present our case series of delayed reverse sural flap. Objective: To determine the outcome of Delayed Distally based sural flaps for distal tibial and foot defects. Materials and Methods: Study was carried out at plastic and reconstructive unit HMC and MMC. Over a period of 10 years from January, 2009 to December, 2018. This is a cross sectional study, presenting with soft tissue defects of foot. Patients presented in the emergency, as an outpatient or as referrals from another center. All patients were admitted and operated as elective cases. Result: In 24 patients, there were no complications. Two patients (6%) had partial flap loss and required revision surgeries. Two patients had marginal flap necrosis and were treated conservatively. Conclusion: This study presents our experience with use of reverse sural flap. It provides a reliable option for foot and distal leg defects. It is relatively easy to do and easy to learn. It can be attempted in centers where expertise or facilities for microvascular surgery are not available and in patients who are not ideal candidates for a free flap. Keywords: Sural flap, Foot and leg defects, Delayed reverse sural flap, Peroneal perforators, Fasciocutaneous flap, Sural angiosome.

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.

Microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle

To explore method and clinical effect of microsurgical thinned anterolateral thigh perforator flap to repair soft tissue defects of foot and ankle. From March 2017 to January 2022, totally 20 patients with soft tissue defects of ankle joint were treated with micro-thinning anterolateral perforator flap for free transplantation, included 13 males and 7 females, aged from 22 to 58 years old with an average of (36.45±12.36) years old. The size of flap ranged from 8.0 cm×5.0 cm to 20.0 cm×12.0 cm. Before operation, perforating vessels on the anterolateral thigh region were detected and marked with a portable Doppler detector. For the defect width less than 8 cm, 11 patients were repaired with a single flap. For the defect width more than 8 cm, the wound could not be sutured directly, and the lobulated flap technique was used in 9 patients, the width was converted to length, and the donor site was closed directly. Under the microscope, all flaps were thinened in a stepwise manner from the center of the pedicle to the periphery. After operation, survival of the flap, the shape, texture, sensory function recovery were observes, and recovery of foot function was evaluated by Maryland foot function evaluation standard. All 20 patients with microsurgical thinned anterolateral thigh perforator flaps were survived. Venous crisis occurred in 1 patient due to subcutaneous hematoma, after removal of the hematoma, the crisis was relieved and the flap survived successfully. The wounds in the donor and recipient sites healed well, and only linear scars left in the donor sites. Twenty patients were followed up for 3 to 26 months after operation, good shape of flaps without bloated, and good texture. The two-point discrimination of free flaps ranged from 9.0 to 16.0 mm, and the protective sensation was restored. The ankle flexion and extension function recovered well and patients could walk normally. According to Maryland foot function evaluation standard, 8 patients got excellent result, 10 patients good and 2 middle. Microsurgical thinned anterolateral thigh perforator flap is an ideal method to repair soft tissue defects in functional area of foot and ankle, with good appearance and texture of the flap, no need for re-plastic surgery, reduced hospitalization costs, and less donor site damage.

Application of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle

To investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle. Between January 2017 and December 2020, 16 cases (17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps. There were 10 males and 6 females, with an average age of 38 years (range, 23-60 years). There were 9 cases of left foot, 6 cases of right foot, and 1 case of bilateral feet. The causes of soft tissue defect were traffic accident injury in 3 cases, heavy object smash injury in 4 cases, machine injury in 3 cases, infection in 4 cases, electrical burn in 1 case, and synovial sarcoma after operation in 1 case. The wounds located at the distal plantar in 2 cases (2 feet), the heel and ankle in 6 cases (6 feet), the dorsum of the foot in 7 cases (8 feet), and the first metatarsophalangeal joint to the medial malleolus in 1 case (1 foot). The size of wounds ranged from 6 cm×5 cm to 18 cm×7 cm. The size of flap ranged from 11 cm×6 cm to 21 cm×9 cm. The donor site was sutured directly. After operation, 1 case (1 foot) of flap vascular crisis, 1 case (1 foot) of partial necrosis of the flap, and 1 case of partial dehiscence of the incision at donor site occurred, all of which healed after symptomatic treatment. The other flaps survived, and the incisions at donor and recipient sites healed by first intention. All patients were followed up 12-36 months (mean, 24 months). Except for 1 case (1 foot) of swollen flap, which underwent two-stage trimming, the other flaps had good shape and texture. All the flaps had a protective feeling. At last follow-up, Kofoed scores of foot and ankle function ranged from 73 to 98 (mean, 89.7); 13 cases were excellent, 2 cases were good, and 1 case was poor, with an excellent and good rate of 93.8%. Linear scar was formed at the donor site without adverse effect on lower limb function. The free transverse gracilis myocutaneous flap is an effective flap for repairing large soft tissue defects of foot and ankle due to its advantages of large excisable area, less variation of vascular anatomy, and concealment of donor site.

Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

How to deal with large soft tissue defects around the foot and ankle is still controversial. The aim of this study was: (1) to display a new pedicled flap, also named the dual-perforator flap with wide pedicle (DPFWP), and (2) to compare it with the sural neurovascular flap with peroneal artery perforator (SNFPAP) in foot and ankle reconstruction. According to different surgical methods, 82 patients were divided into 2 groups: the DPFWP group (42 cases) and the SNFPAP group (40 cases). All cases underwent a flap surgery after radical debridement. The 2 groups were homogeneous in terms of age, sex, body mass index (BMI), etiology, location, and follow-up duration. Operation indexes were compared, including flap length, flap width, operation time and blood loss. Complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. The DPFWP group had larger flap length (24.5 ± 4.6 cm vs 16.3 ± 3.8 cm), and flap width (10.5 ± 2.7 cm vs 7.8 ± 1.7 cm) than the SNFPAP group. In postoperative follow-up, DPFWP group showed a lower complication rate and better cosmetic, functional outcomes than SNFPAP group. In conclusion, this study showed that a DPFWP flap brought better results than a SNFPAP flap in terms of complications, cosmetic appearance, and functional outcomes for patients undergoing reconstruction of foot and ankle defects.

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.

Abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle

To investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle. Between June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly. During the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months. The abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.

Clinical application of free peroneal artery perforator flap in soft tissue defect of foot and ankle

To investigate clinical application of the free peroneal artery perforator flap in soft tissue defect of foot and ankle. The clinical data of 18 patients with soft tissue defects of foot and ankle who were repaired with free peroneal artery perforator flaps between March 2019 and March 2020 were retrospectively analyzed. Among them, there were 11 males and 7 females; the age ranged from 21 to 58 years, with an average age of 45 years. The defect was located in the ankle in 2 cases, in the hindfoot in 4 cases, in the midfoot in 5 cases, and in the forefoot in 7 cases. The causes of injury included 11 cases of traffic accident, 4 cases of machine injuries, 3 cases of infection and necrosis after internal fixation. The time from injury to flap repair was 12-48 days, with an average of 24 days. The range of wound was 3 cm×3 cm to 15 cm×8 cm, and the range of skin flap was 4 cm×3 cm to 16 cm×9 cm. The flap harvesting time, operation time, intraoperative blood loss, and complications were recorded; the flap survival and patient satisfaction were observed during follow-up; and the American Orthopaedic Foot and Ankle Society (AOFAS) foot function score was used to evaluate the foot function. The flap harvesting time was 15-33 minutes (mean, 22 minutes); the operation time was 120-160 minutes (mean, 150 minutes); the intraoperative blood loss was 90-180 mL (mean, 120 mL). There were 3 cases of vascular crisis after operation, including 2 cases of arterial crisis, which survived after vascular exploration and vein graft repair; 1 case of venous crisis, partial necrosis of the skin flap, and skin grafting to cover the wound after repeated debridement. The remaining 15 skin flaps survived completely. All patients were followed up 6 months. The skin flaps were in good shape without obvious bloat. According to the AOFAS foot function score, 5 cases were excellent, 10 cases were good, and 3 cases were fair. The excellent and good rate was 83.3%. The free peroneal artery perforator flap is easy to harvest, the shape and size of the flap are easy to design, and it does not damage the main blood vessels of the limb. The appearance and function of the limbs are satisfactory after operation. It can be widely used in the repair of soft tissue defects of the foot and ankle.

Application of the flap pedicled with superior malleolus perforator of anterior tibial artery in reconstruction of soft tissue defects in foot and ankle

Objective To explore the clinical effects of the flap pedicled with superior malleolus perforator of anterior tibial artery in reconstruction of the soft defects in foot and ankle. Methods A retrospective study was carried out to analyze 19 patients with soft tissue defects in foot and ankle. Ninteen patients, which were 11 males and 8 females and aged 21-75 (mean, 39) years, received the surgery between April, 2018 and June, 2019. According to the anatomy of superior malleolus perforating flaps and the size and shape of the soft tissue defects in foot and ankle, flaps were designed and harvested in the anterolateral side of the shank. The sizes of flaps were 6.0 cm×5.0 cm-14.0 cm ×8.0 cm. Evaluation of clinical effects included flap survival, infection control, the elasticity, color, appearance and scars of the donor sites, skin sensations and patient satisfaction. The swelling of flap was also took into an account. Results All 19 flaps survived after the surgery. The soft tissue defects and exposure of tendon, bone and steel plate were repaired very well. Both the donor and recipient sites healed at stage I. Duration of out-patient clinic followed-up was 2-16 months. All flaps survived very well with good shape, and the color and elasticity were very close to the nearby normal skin. Scars at donor sites were small and the functions of ankle and foot were satisfactory. Conclusion The flap pedicled with superior malleolus perforator of anterior tibial artery in reconstruction of the soft tissue defect in foot and ankle delivered satisfactory clinical effects. This flap has reliable perforating blood vessels hence reliable blood supply with high survival rate of flaps. It is one of the simple, safe and optimal methods to repair soft tissue defects in foot and ankle. Key words: Anterior tibial artery perforator flap; Superior malleolus perforator; Foot and ankle; Soft tissue defects; Repair

Reconstruction of moderate-sized soft tissue defects in foot and ankle in children: Free deep inferior epigastric artery perforator flap versus circumflex scapular artery perforator flap

This retrospective study was conducted to compare the outcomes between the free deep inferior epigastric artery perforator (DIEP) flap and the circumflex scapular artery perforator (CSAP) flap in reconstruction of moderate-sized soft tissue defects in the foot and ankle of pediatric patients. From January 2004 to December 2016, 42 patients, ranging from 2 to 13 years old, underwent foot and ankle reconstruction, with a free DIEP flap in 21 cases and a free CSAP flap in the other 21cases. All the flaps survived. No marked differences were observed in the demographics, flap size, recipient vessels, and overall early or late complication rate (p>0.05). The CSAP group had a shorter operation time (134.3 ± 25 min vs. 202.4 ± 24.3 min, p<0.05) and flap harvest time (29.7 ± 8.1 min vs. 52.2 ± 9.8 min, p<0.05) than the DIEP group had. In long-term follow-up, the CSAP group showed a lower fat hyperplasia rate (14% vs. 52%, p<0.05) and better cosmetic outcomes than the DIEP group did (p<0.05). The functional outcomes had no marked differences (p>0.05). The DIEP flap and the CSAP flap are both good options for foot and ankle reconstruction of moderate-sized defects in pediatric patients. The CSAP flap has a shorter operation time and flap harvest time, a lower fat hyperplasia rate, and better long-term cosmetic outcomes than the DIEP flap does.

Repair of soft tissue defect of foot and ankle with the supercharged peroneal artery perforator propeller flap

Objective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap, and to provide theoretical support by anatomical observation. Methods From January, 2010 to February, 2018, a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap. Cause of injury: trauma in 7 cases, wound ulcer in 1 case, and poor healing of the calcaneus incision in 2 cases. Defect site: 5 cases of heel, 2 cases of medial and lateral malleolus, and 3 cases of dorsum and sole. The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm. All patients were followed-up at 1, 3, 6 months after operation, and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively. From November, 2016 to May, 2017, the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized. Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived. Two of them had local epidermal necrosis at the proximal end of the flap. After 1 to 2 weeks of dressing, they finally healed. The other 8 cases healed well. Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions. Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the big paddle artery of the flap, preventing distal necrosis. Key words: Peroneal artery perforator flap; Propeller flap; Supercharged; Foot and ankle

Effect of lateral malleolus perforator flap for the repair of soft tissue defect of foot and ankle

Objective To study the effect of lateral supramalleolar perforator flap for skin and soft tissue defect of lateral malleolus. Methods From January 2012 to December 2015, 36 patients with soft tissue burn of ankle in the Traditional Chinese Medicine Hospital of Cixi were selected as study objects.The average wound area was 4~10cm.The average flap size was 5~13cm.There were 17 cases received skin flap of behind perforator of the lateral malleolus.There were 19 cases received skin flap of front perforator of the lateral malleolus.The effect of repair was observed. Results All flaps survived in 36 cases after operation.There were 7 cases of 2.6cm of blood stasis, and necrosis occurred in 2 cases which healed after dressing change.Transplantation of skin flap and the original skin had good adhesion, skin color and texture was similar to the surrounding skin during the follow-up period of 6 to 12 months.The survival time and walk time of the repair of anterior perforator flap were (2.20±0.70)weeks, (4.70±1.10)weeks, respectively, which were longer than those of the lateral retromalleolar perforator flap[(2.10±0.80)weeks, (4.20±1.10)weeks], but the differences were not statistically significant (all P>0.05). The American orthopaedic foot and ankle society(AOFAS) score of the anterior perforator flap was significantly lower than that of the lateral retromalleolar perforator flap, the difference was statistically significant[(77.47±3.41)points vs.(80.12±4.12)points, t=2.110, P<0.05]. Conclusion Lateral supramalleolar perforator flap has significant effect for skin and soft tissue defect of lateral malleolus.The operation is simple, the success rate is high, it is worth to be popularized in clinical. Key words: Ankle injuries; Soft tissue injuries; Surgical flaps; Reconstructive surgical procedures

Reverse sural artery flap: a reliable alternative for foot and ankle soft tissue reconstruction.

Soft tissue defects of foot and ankle are challenging due to the susceptibility of the area to trauma and the complexity of the region. Several flaps have been described for wound coverage after surgical debridement at this location. The purpose of this study is to present the reverse sural flap for covering soft tissue defectsat the ankle and foot. From July 2014 to November 2017, ten patients with soft tissue defect at the ankle and foot were retrospectively reviewed. There were nine men and one woman with a mean age of 40.5 years (range 17-71 years). Seven patients were smokers and five were diabetics. The mean size of the defect was 50.5 cm2. All operations were performed by the same microsurgical team. At a mean follow-up of 21 months (range, 18 to 24 months), we evaluated wound healing and complications. In nine patients, the soft tissue defect was successfully covered. In four patients, venous congestion was noticed, whereas in one patient, there was total necrosis of the flap. In all cases, the donor site was healed uneventfully. The reverse sural artery flap is a reliable alternative for wound coverage at the ankle and foot, with low complication and morbidity rate. Nevertheless, it is a demanding microsurgicaloperation that requires knowledge of the anatomy and surgeons' experience.

Repair the large area soft tissue defect of foot and ankle with free bilateral anterolateral femoral perforator flap in series

Objective To investigate the clinical effect of free bilateral anterolateral femoral perforator flap in repairing large area soft tissue defects of foot and ankle. Methods From July, 2013 to December, 2017, 30 patients(19 males and 11 females) with large soft tissue defects of ankle and foot were treated, aged 21-52 years. The defects were located in the middle and distal part of the foot and ankle, the wounds were all exposed with bone, tendon or internal fixator, and the area of skin defect was 15 cm × 22 cm-19 cm× 28 cm. All of them were repaired by free bilateral anterolateral femoral perforator flaps. The perforating branch of bilateral flap was determined by CDU or DSA before operation. According to the area of skin defect and the shape of wound, an appropriate perforating branch flap was designed in the anterolateral thigh region. One perforating branch flap was used as the proximal series flap, the proximal vessel pedicle was anastomosed with the recipient region arteriovenous flap. The other perforating branch flap was used as the distal series flap, the artery and vein were anastomosed between the two flaps. The total area of the two flaps was 17 cm × 25 cm-23 cm × 32 cm. The survival of the flap and the functional recovery of the repair site were observed and the clinical effect was evaluated. Results There was no vascular crisis after operation, and the flaps survived. Followed-up for 5-28(mean, 13.5)months showed that the flap had good blood flow, soft texture and good elasticity, among which 4 cases were slightly bloated and improved after plastic operation. After operation, 26 cases were excellent(90-100 points), 4 cases were good(75-89 points), and the average score of AOFAS was 93.8 points. Conclusion The traffic accident of anterolateral perforating branch and the attention in the process of flap cutting and series were summarized. Key words: Foot; Ankle; Anterolateral femoral perforator flap; Repair; Microsurgical operation

Reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting

Objective To investigate the clinical effect of reconstruction of soft tissue defect in non-weight-bearing area of the foot with trimmed free anterolateral thigh muscle flap combined with skin grafting. Methods From January, 2009 to January, 2017, 25 patients with soft tissue defect in foot and ankle were treated with transplantation of the trimmed free anterolateral thigh muscle flap combined with skin grafting. Of the 25 cases, there were 5 cases located in medial foot, 10 cases in dorsum of foot, 7 cases in external of foot and 3 cases in the toe. The areas of wounds were 8.0 cm×6.0 cm to 18.0 cm×10.0 cm. The anterolateral thigh muscle flap was from 4.0 cm×3.0 cm×0.3 cm to 10.0 cm×8.0 cm×1.5 cm. All the cases were operated in fracture fixation and wound without obvious infection. Early rehabilitative exercise under the protection of orthosis were done after 4 weeks of the operation and to assess. The injuried limb function were assessed in 1 year postoperatively according to Marylands scale. Results All cases were followed-up for 12 to 24 months (average, 16.2 months) . All the muscle flaps and skin survived. The healing time were 12 to 24 days, averaged of 17.1 days. Patients could wear shoes normally and resume normal life and work. The appearance and walking function were satisfying and no further debulking procedures were needed. The surgery function were assessed according to Marylands scale, and the results was 22 cases for excellent, and 3 cases for good. Conclusion Ttrimmed free anterolateral thigh muscle flap combined with skin grafting is a good option for the repair of foot and ankle defect at non-weight-bearing area, and it has the advantages such as the doner site is small invasive, the muscle flap is easy to be harvested, and can avoid debulking surgery to wear shoes normally. Key words: Anterolateral thigh muscle flap; Foot; Transplantation; Soft tissue defect; Microsurgical technique

Clinical research of vacuum sealing drainage combined with artificial dermis for the treatment of ankle and foot soft tissue defects

To investigate the effect of vacuum sealing drainage (VSD) combined with artificial dermis for treatment of the ankle and foot soft tissue defects. A total of 15 patients with skin and soft tissue defect of ankle and foot were treated from January 2011 to December 2013, including 10 males and 5 females, with an average age of 32.5 years old ranging from 3 to 55 years old, involving 8 cases by traffic accident, 2 cases by machine accident, 5 cases by crush injury;8 cases with soft tissue exposure, 2 cases with tendor exposure, 5 cases with bone exposure. VSD was used to cover the wounds and continuous negative pressure drainage after debridement, the wounds covered with artificial dermis after the second granulation tissue grew well, again VSD was used to cover the wounds and negative pressure suction was applied, after 7 to 14 days negative pressure closed drainage was removed, free skin graft was transplanted above the artificial dermis, sterile gauze was used to compression bandage. All cases were followed up for 3 to 14 months with an average of 6.5 months. Skin graft of 15 of patients survived after transplantation, artificial dermis graft interval was 7 to 14 days with an average of 9.5 days. There was no obvious scar hyperplasia and contracture, no obvious pigmentation, appearance and functional recovery. After the implantation of artificial dermis and traditional skin graft method need for 2 to 3 weeks, vacuum sealing drainage technique combined with artificial dermis in treatment of soft tissue defect of foot and ankle skin has advantages of simple operation, significantly shorten the time of the second phase of the skin, without flap to repair, little injury to donor skin area, wound healing quality high, clinical effect of satisfaction.

Repairing defects of foot and ankle by sural neurovascular adipofascial flap

Objective To investigate the clinical effect of repairing soft tissue defects of foot and ankle by sural neurovascular adipofascial flap.Methods Application of sural neurovascular adipofascial flap to repaire soft tissue defects of foot and ankle in 19 patients,inclouding 3 csaes with the soft tissue defects of medial malleolus and 16 cases of dorsum pedis from May,2006 to May,2013.The size of soft tissue defects was 3 cm ×3 cm-7 cm ×9 cm.The skin of the donor site was sutured directly.The recipient area was reshaped granulation and underwent free skin graft after the adipofascial flap survived.Results After followed up of 3-18 months,the adipofascial flaps were all survived,the recipient area was almost flat with the surrounding tissue,the donor area only leaving linear scar,the appearance and function of donor area and adopt area were satisfactory.The sensation of lateral dorsal region of foot decreased to S3,and the sensation of recipient site recovered to S2.There were some changes in pigmentation with the skin graft region.Conclusion Sural neurovascular adipofascial flap can be effectively repaired soft tissue defects of foot and ankle,and it can avoid irregularity of donor area and enlargement of adopt area,the appearance and function were satisfactory. Key words: Sural nerve ; Adipofascial flap ; Foot ; Ankle ; Microsurgical operation

The Extended Distally Based Sural Neurocutaneous Flap for Foot and Ankle Reconstruction

The distally based sural neurocutaneous flap has been used for coverage of defects in foot and ankle for years. Conventional flaps do not extend to the upper third of the leg, which limits its application. The current study presents results using extended distally based sural neurocutaneous flaps for reconstruction of extensive soft tissue defects of the foot and ankle in 21 patients. All injuries occurred from 2001 to 2011 as a result of a traumatic event. Follow-up of 21 patients ranged from 7 months to 5 years after surgery. All 21 flaps survived successfully. The largest flap used measured 26 × 15 cm. Complications included 1 distal marginal necrosis and 2 slight venous congestions. The extended distally based sural neurocutaneous flap is a good alternative for extensive soft tissue defects of foot and ankle. The operative techniques with several simple modifications in harvesting the flaps are easy to handle and will not prolong the operation time.

Enhancement of Venous Drainage with Vein Stripper for Reversed Pedicled Neurocutaneous Flaps

The flaps based on the vascular axis of superficial sensitive cutaneous nerves had gained increased popularity in reconstructive surgery because of such major advantages as preservation of major extremity arteries and avoidance of microsurgical procedures. However, postoperative venous congestion resulting in partial or total necrosis is still a common problem for these flaps. The aim of the current study is to introduce a new method for reducing the postoperative venous congestion of neural island flap with the results of reconstruction of the soft tissue defects of foot and ankle. This method was used to treat 19 patients with various chronic soft tissue defects of the foot and ankle between 2011 and 2012. We observed that the novel method presented in this report enables effective venous drainage, solving the postoperative venous congestion problem of these flaps.

Reconstruction of the Soft Tissue Defects of Foot and Ankle with Neural-Island Flaps: Mono-Institutional Case Series

The aim of this report is to show the results obtained from using the neural-island flap to cover the soft tissue defects of the foot and ankle. This is the first report of the neural-island flap series since the introduction of this flap to the literature in 2003. Between 2002 and 2009 "neural-island flap" was used to treat 20 patients of various lesions on the foot and ankle. All of the patients had serious soft tissue defects that compromised tendons, bones, or joints. In 16 patients, the tissue defects were completely and successfully covered with an uncomplicated postoperative course. In 4 patients the flaps presented venous congestion and intermittent bleeding and leech application was performed for 2 to 3 days postoperatively. Two of these flaps healed completely without any flap loss. In one patient because the partial flap necrosis occurred in distal one-fourth of the flap, skin grafting was performed after 1 week of vacuum-assisted closure application. Total flap necrosis occurred in only one patient who was suffering from Buerger disease. The authors conclude that the neural-island flap is a highly versatile, easy, and reproducible flap that avoids the use of complicated and risky reconstruction options. It can be considered as an alternative reconstruction option particularly in problematic cases that are not suitable for local or free tissue transfers.