Search

REVERSED SURAL NEUROVASCULAR FASCIO-CUTANEOUS FLAP FOR RECONSTRUCTION OF SOFT-TISSUE DEFECTS IN ANKLE AND FOOT

Objective To evaluate clinical significance of reversed sural neurovascular fasciocutaneous flap for reconstruction of softtissue defects in ankle and foot. Methods From July 1994 to December 2002, 52 cases of soft-tissuedefects in the ankle and foot were reconstructed by use of reversed sural neurovascular fascio-cutaneous flap, including 47 cases of traumatic defects, 3 cases of chronic ulcer and 2 cases of tumors. The flap area ranged from 4 cm×6 cm to 10 cm×21 cm. Results The flaps survived in 48 cases; the distal part necrosed and secondary free-skin graft were further conducted in 4 cases. All soft-tissue defects were repaired and their accompanied bone and tendon exposurehealed. Forty-six cases were followed-up for 5 months to 48 months, the color and texture of the flaps were excellent and 2point discrimination was 11-17 mm(14 mm on average).The functions of ankle joints were good.Conclusion The reversedsural neurovascular fascio-cutaneous flap is convenient in design and dissection. Its use can retained and replace vascular anostomosed flaps to certain degrees.

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

ObjectiveTo 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.MethodsBetween 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.ResultsDuring 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.ConclusionThe 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.

内踝上皮支皮瓣修复足踝部皮肤软组织缺损

The Repair of Lower Leg, Ankle and Foot Soft Tissue Defects

目的　评价不同皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损的效果，探讨小腿及足踝部皮肤软组织缺损的理想修复方法。 方法　2002年6月－2010年1月，应用15种皮瓣、肌皮瓣修复128例（138处）小腿及足踝部皮肤软组织缺损。其中小腿中上段21处，小腿中下段45处，内外踝及足跟部43处，足背及前足29处。主要应用最多的皮瓣有腓肠神经营养血管皮瓣、腓肠肌内外侧头肌皮瓣、腓浅神经营养血管皮瓣和足底内侧皮瓣。修复软组织缺损范围5 cm×4 cm～23 cm×14 cm。 结果　术后135处创面Ⅰ期愈合，皮瓣完全成活；2处皮瓣部分坏死，经二次手术植皮修复；1例游离股前外侧皮瓣修复小腿中下段软组织缺损，皮瓣完全坏死，后改取对侧腓肠神经营养血管交腿皮瓣修复成活。腓肠神经营养血管皮瓣应用例数最多，成活率高，吻合血管的游离皮瓣坏死率较高。术后患者均获随访1～10年，平均23个月，皮瓣均成活良好, 无溃疡、渗液等。 结论　正确认识并选择皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损可提高皮瓣成活率，恢复肢体良好功能，腓肠神经营养血管皮瓣是一种修复小腿及足踝部软组织缺损的理想皮瓣。

PROGRESS AND MAIN POINTS IN TREATMENT OF ACUTE FOOT AND ANKLE INJURIES

Objective To give a review and commentary on the treatment of acute foot and ankle injuries. Methods Based on the treatment experience and recent l iterature, a commentary on acute foot and ankle injuries were given, included the basic and cl inical research results, evaluation before operation, and treatment methods of the soft tissue and bone injuries. Results The treatment of acute foot and ankle injuries is still a hot point in orthopaedic surgery. Operative and non-operative treatment of fresh Achilles tendon rupture can achieve satisfactory results, and early weight-bearing do not increase the re-rupture rate. The time delay between first debridement and injury within 24 hours does not increase the infection rate. For the treatment of severe ankle fractures, attentions should be paid to the cartilage injury, and anatomic reduction, good real ignment, and the congruity recovery are very important. The treatment determination of calcaneal fractures depends on the fully understanding injury mechanisms, classifications, and treatment method. Talus fractures should try to be treated by experienced surgeons. Operation and fixation methods of Lisfranc injury depends on different injury types. Conclusion Acute foot and ankle injuries are common in cl inical, to achieve a satisfactory result in evaluation and treatment, it is important to have a fully evaluation of the injury type, and choose the best operation time and suitable treatment methods, as well as to fully understand the biomechanical characteristics of different regions.

腓肠神经营养血管皮瓣修复足踝部软组织缺损

总结腓肠神经营养血管皮瓣修复足、踝部软组织缺损的临床效果。 方法 2003 年3 月－2006 年7 月，应用腓肠神经营养血管皮瓣修复足、踝部软组织缺损18 例，其中男10 例，女8 例；年龄6 ～ 52 岁。皮带、车链绞伤15 例，砸伤3 例。合并踝关节、跗骨、跖骨骨折脱位5 例，跟踺缺损2 例，感染5 例。软组织缺损8 cm ×6 cm ～ 17 cm× 8 cm。行急诊手术8 例；择期手术10 例。同时行关节和骨折内固定5 例，置管持续冲洗2 例，跟腱修复2 例。 结果 18 例皮瓣均成活。15 例伤口Ⅰ期愈合；1 例皮瓣边缘表层坏死，经换药、植皮后愈合；2 例伤口感染，换药后愈合。患者获随访8 个月～ 3 年，皮瓣外形、色泽、质地良好，踝关节功能满意。背屈18 ～ 20°，跖屈30 ～ 35°。 结 论 腓肠神经营养血管皮瓣血运良好，操作简便、安全，可有效修复足、踝部软组织缺损。

股前外侧皮瓣游离移植修复足踝部大面积皮肤软组织缺损

目的 总结股前外侧皮瓣修复足踝部大面积皮肤软组织缺损的临床应用效果。 方法 2007 年1 月－2010 年12 月，采用股前外侧皮瓣修复30 例足踝部大面积皮肤软组织缺损。男18 例，女12 例；年龄18 ～ 55 岁，平均36 岁。外伤19 例，烧伤4 例，慢性感染创面7 例。病程9 h ～ 8 个月。缺损部位：小腿下1/3 及跟腱区8 例，外踝及足背外侧区10 例，内踝及足背内侧区5 例，足跟及足底7 例。创面均伴血管、骨及肌腱外露。创面缺损范围20 cm × 14 cm ～ 23 cm ×21 cm。皮瓣切取范围为22 cm × 16 cm ～ 25 cm × 23 cm。供区游离植皮修复。 结果 术后5 ～ 7 d 3 例皮瓣边缘出现部分坏死，予以加强换药后成活；其余皮瓣及供区植皮均顺利成活，创面均Ⅰ期愈合。患者均获随访，随访时间6 ～ 36 个月，平均18 个月。皮瓣耐磨，无局部溃烂，其中27 例恢复保护性感觉。但皮瓣外形臃肿，12 例于术后1 年行二次手术皮瓣修整后，外形满意。 结论 股前外侧皮瓣具有切取范围大、血管口径粗、部位隐蔽等特点，是修复足踝部大面积皮肤软组织缺损的有效方法之一。

Reconstruction of the donor area of distally based sural flap with relaying lateral gastrocnemius artery perforator propeller flap

Objective To investigate the clinical application of relaying lateral gastrocnemius artery perforator flap in reconstruction of the donor defect after distally sural flap transferring. Methods Between January 2014 and January 2016, 12 cases with foot and ankle defects were treated. There were 10 males and 2 females with an average age of 23.4 years (mean, 14-52 years). The injury was caused by motorcycle accident in 7 cases and traffic accident in 5 cases. The injury located at left limb in 7 cases and right limb in 5 cases. The size of soft tissue ranged from 10 cm×4 cm to 12 cm×6 cm. The disease duration was 2-84 hours (mean, 26.2 hours). The foot and ankle defects were reconstructed by distally sural flaps, then the flap donor sites were reconstructed with relaying lateral gastrocnemius artery perforator flap at the same stage. The size of distally sural flap ranged from 11 cm×5 cm to 13 cm×7 cm. The size of relaying flap ranged from 7 cm×4 cm to 10 cm×6 cm. Results All flaps survived uneventfully. All recipient sites and donor sites healed smoothly. No vascular crisis, wound dehiscence, or evident swelling occurred. All patients were followed up 6-14 months (mean, 12.4 months) with satisfied esthetic and functional results in recipient and donor sites. There were only linear scar on the donor sites. The color and contour was satisfying, the function of calf and foot were not affected. Conclusion The relaying lateral gastrocnemius artery perforator flap combined with distally sural flap is an idea choice to reconstruct foot and ankle defect, which can avoid donor site skin grafting, minimize donor site morbidity.

足踝部皮肤软组织缺损的修复

【摘 要】 目的 总结足踝部皮肤软组织缺损修复方法及疗效。 方法 2005 年8 月－ 2008 年8 月，收治46 例足踝部皮肤软组织缺损患者。男40 例，女6 例；年龄12 ～ 68 岁，平均35 岁。交通事故伤31 例，机器碾压伤6 例，医源性损伤2 例，电击伤1 例，糖尿病足溃疡6 例。缺损范围4 cm × 2 cm ～ 27 cm × 16 cm。病程4 h ～ 2 年。采用股前外侧游离皮瓣12 例，腓肠神经营养血管皮瓣25 例，胫后动脉逆行皮瓣1 例，隐神经皮瓣2 例，腓动脉终末穿支皮瓣2 例，交腿皮瓣1 例，足底内侧皮瓣2 例，跖背皮瓣1 例，皮瓣切取范围4 cm × 3 cm ～ 28 cm × 18 cm；供区直接缝合或中厚皮片游离移植修复。 结果 术后46 例患者均获随访，随访时间6 个月～ 3 年，平均11 个月。术后10 d 2 例腓肠神经营养血管皮瓣发生远端部分坏死；其余皮瓣均成活，创面Ⅰ期愈合。供区植皮均成活，无明显挛缩；切口Ⅰ期愈合。术后6 个月，1 例采用腓肠神经营养血管皮瓣修复的足底创面发生小面积溃疡，经对症处理后愈合；其余患者皮瓣质地、色泽正常。患者可负重行走，步态正常。 结论 合理采用局部带蒂皮瓣或游离皮瓣修复足踝部皮肤缺损，可明显缩短病程，达到保肢保足目 的。

Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children

Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children. Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed. There were 18 boys and 10 girls with an average age of 7.3 years (range, 6-14 years). There were 8 cases of traffic accident injury and 20 cases of chronic infection wound. The disease duration was 2-4 months, with an average of 2.8 months. After thorough debridement, the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm. Repairing was performed after 7-28 days of the infection in control. According to the location, size, and shape of the wound, the perforating vessels were located by ultrasonic Doppler, and the perforator propeller flap (area ranged from 6 cm×5 cm to 11 cm×6 cm) was designed and harvested to repair the wound. Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases. The donor site was sutured directly (22 cases) or repaired with skin graft (6 cases). Results Twenty-six flaps survived, of which 20 cases were in primary healing, and 6 cases had epidermal necrosis at the end of small paddle, which healed after dressing change. Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation. Primary wound healing was achieved in donor site. All 28 children were followed up 6-24 months (mean, 10.5 months). The texture, shape, and motor function of the lower limb was satisfactory. At last follow-up, the American Orthopaedic Foot and Ankle Association (AOFAS) score was 89.8±8.0, which was significantly different from the preoperative score (79.6±10.4) (t=−11.205, P<0.001); 20 cases were excellent, 6 cases were good, and 2 cases were poor, and the excellent and good rate was 92.8%. ConclusionThe perforator propeller flap of lower limb in children has its own characteristics. It is a reliable method to repair the foot and ankle defect in children.