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Title: [Repairing the bone and skin defect of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery].
Author: Wei YT, Zhong GW, Tang TG, Liang HH, Yao J, Sun FQ.
Journal: Zhonghua Yi Xue Za Zhi; 2018 Sep 04; 98(33):2656-2660. PubMed ID: 30220154.
Abstract:
Objective: To evaluate the clinical outcome of repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery. Methods: Twelve patients of toe defect after reconstruction were repaired from March, 2015 to June, 2017 utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery in the Department of Hand and Foot Microsurgery of Xin'an Hospital, Dongguan City.Of which, there were 7 cases of great toe defect with fibular side of phalanx ungual and skin, 5 cases of second toe defect with proximal interphalangeal joints and the partial bone accompanied the great toe defect.Double bone flaps of one pedicles were used to repair first and second phalanx defect in 5 cases.The skin injured area: 5.5 cm×2.5 cm to 6.5 cm×10.0 cm. Bone defect size of great and second toe were 1.5 cm×1.0 cm×0.8 cm to 1.7 cm×1.0 cm×1.0 cm and 2.5 cm×1.0 cm×1.0 cm to 4.0 cm×1.0 cm×1.0 cm, respectively.The flap size ranged from 6.0 cm×3.0 cm to 6.5 cm×12.0 cm, and the bone flap size ranged from 1.5 cm×1.0 cm×0.8cm to 1.7 cm×1.0 cm×1.0 cm(great toe) and 2.0 cm×1.0 cm×1.0 cm to 3.5 cm×1.0 cm×1.0 cm(second toe). The wound of donor site of the leg was directly combined or local skin transfer sutured with 8 cases, skin-grafting in 4 cases. Results: All the bone-skin flaps survived.After 6-27 months of follow-up, the great toe flaps were found with normal color, good texture and moderate thickness, the two-point discrimination was 7-10 mm. The donor site of the leg showed little influence with normal function.No pain and discomfort in the foot were recorded, and the patients walked well.The healing time of bone flap was from 1.5 to 4 months, with an average of 2.5 months.Using the Maryland Foot Score, 5 cases of 7 feet got excellent and 2 cases of 2 feet got good result in the great toe group (7 cases of 9 feet), the good rate was 100%.Three cases got excellent and two cases got good result in the combined reconstruction group (5 cases), the good rate was 100%. Conclusion: Repairing donor site of foot after improved toe-to-finger reconstruction utilizing periosteal perforator bone-skin flap of proximal anterior tibial artery can also repair bone and skin defect of the great and the second toe, keep the great and the second toe, and restore the appearance and function of the first and the second toe at utmost. 目的： 探讨游离胫前动脉近端骨膜穿支骨皮瓣修复再造术后足部供区的临床疗效。 方法： 2015年3月至2017年6月，东莞市新安医院手足显微外科应用胫前动脉近端骨膜穿支骨皮瓣移植修复再造后足部供区12例，其中踇趾皮肤及末节趾骨腓侧伴缺损7例，合并第2趾近趾关节及部分趾骨缺损5例。后5例均采用一蒂双骨瓣分别修复踇、第二趾骨缺损。足部供区皮肤缺损面积：5.5 cm×2.5 cm～6.5 cm×10.0 cm，第一趾骨缺损大小：1.5 cm×1.0 cm×0.8 cm～1.7 cm×1.0 cm×1.0 cm，第二趾骨、关节缺损大小：2.5 cm×1.0 cm×1.0 cm～4.0 cm×1.0 cm×1.0 cm。应用皮瓣面积：6.0 cm×3.0 cm～6.5 cm×12.0 cm，应用骨瓣大小：1.5 cm×1.0 cm×0.8 cm～1.7 cm×1.0 cm×1.0 cm(第一趾)、2.0 cm×1.0 cm×1.0 cm～3.5 cm×1.0 cm×1.0 cm(第二趾)。胫前区创面直接缝合或皮肤局部转移8例，植皮4例。 结果： 术后骨皮瓣全部成活。随访6～27个月，踇趾皮瓣色泽正常，质地良好，厚薄适中，皮瓣两点辨别觉7～10 mm。小腿胫前区外观影响小，功能正常，足部无疼痛不适，不影响走路。移植骨瓣愈合时间1.5～4.0个月，平均2.5个月。采用Maryland足部评分踇甲、骨瓣组7例9足优5例7足、良2例2足，优良率100%；组合再造组5例优3例、良2例，优良率100%。 结论： 应用胫前动脉近端骨膜穿支骨皮瓣修复再造术后足部供区，能同时修复踇、第二趾骨皮肤缺损，保留踇、第二趾，最大程度恢复第一、二趾外观和功能。.

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