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Title: [Reconstruction of ankle and foot with combination of free perforator flaps and skin graft].
Author: Yin L, Gong K, Yin Z, Zhang B, Xu J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2017 Mar 15; 31(3):319-322. PubMed ID: 29806261.
Abstract:
OBJECTIVE: To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. METHODS: Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. RESULTS: Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. CONCLUSION: Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot. 目的: 探讨应用游离穿支皮瓣结合游离植皮修复足踝部软组织缺损的临床效果。. 方法: 2014 年 6 月—2015 年 10 月，收治 20 例足踝部软组织缺损患者。其中男 16 例，女 4 例；年龄 19～61 岁，平均 43.3 岁。致伤原因：交通事故伤 7 例，重物压砸伤 9 例，机器绞伤 4 例。创面部位：踝关节周围 6 例，足跟 3 例，足背 4 例，脱套伤截趾术后残端及前足底 7 例。创面范围 15 cm×10 cm～27 cm×18 cm。受伤至手术时间 11～52 d，平均 27 d。采用游离穿支皮瓣联合游离植皮方法修复，其中股前外侧穿支皮瓣 11 例，腓肠内侧动脉穿支皮瓣 4 例，胸背动脉穿支皮瓣 3 例，腹壁下动脉穿支皮瓣 1 例，股前内侧动脉穿支皮瓣 1 例。其中采用嵌合穿支皮瓣 5 例，分叶穿支皮瓣 5 例，血流桥接穿支皮瓣 3 例（以血流桥接的方式将 2 个穿支皮瓣串联），联体穿支皮瓣 3 例。皮瓣切取范围 10.0 cm×6.5 cm～36.0 cm×8.0 cm；皮片切取范围为 5 cm×3 cm～18 cm×12 cm。. 结果: 术后 18 例皮瓣成活；2 例出现静脉危象致皮瓣坏死，经对症处理后成活。其余患者皮瓣及植皮均成活，创面Ⅰ期愈合。供区切口Ⅰ期愈合。20 例均获随访，随访时间 4～18 个月，平均 8.3 个月。受区无感染发生，皮瓣质地、颜色良好；足部恢复日常行走功能。供区仅遗留线性瘢痕。. 结论: 游离穿支皮瓣能修复足踝部任何区域，尤其是前足底负重区域创面，且供区损伤小，联合游离植皮是一种治疗足踝部软组织缺损的理想方法。.

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