Objective To discuss the feasibil ity of repairing soft tissue defects of lower extremity with a distally based posterior tibial artery perforator cross-bridge flap or a distally based peroneal artery perforator cross-bridge flap. Methods Between August 2007 and February 2010, 15 patients with soft tissue defect of the legs or feet were treated. There were 14 males and 1 female with a mean age of 33.9 years (range, 25-48 years). The injury causes included traffic accident in 8 cases, crush injury by machine in 4 cases, and crush injury by heavy weights in 3 cases. There was a scar (22 cm × 8 cm atsize) left on the ankle after the skin graft in 1 patient (after 35 months of traffic accident). And in the other 14 patients, the defect locations were the ankle in 1 case, the upper part of the lower leg in 1 case, and the lower part of the lower leg in 12 cases; the defect sizes ranged from 8 cm × 6 cm to 26 cm × 15 cm; the mean interval from injury to admission was 14.8 days (range, 4-28 days). Defects were repaired with distally based posterior tibial artery perforator cross-bridge flaps in 9 cases and distally based peroneal artery perforator cross-bridge flaps in 6 cases, and the flap sizes ranged from 10 cm × 8 cm to 28 cm × 17 cm. The donor sites were sutured directly, but a spl it-thickness skin graft was used in the middle part. The pedicles of all flaps were cut at 5-6 weeks postoperatively. Results Distal mild congestion and partial necrosis at the edge of the skin flap occurred in 2 cases and were cured after dressing change, and the other flaps survived. After cutting the pedicles, all flaps survived, and wounds of recipient sites healed by first intention. Incisions of the donor sites healed by first intention, and skin graft survived. Fifteen patients were followed up 7-35 months with an average of 19.5 months. The color and texture of the flaps were similar to these of the reci pient site. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system, the mean score was 87.3 (range, 81-92). Conclusion A distally based posterior tibial artery perforator cross-bridge flap or a distally based peronealartery perforator cross-bridge flap is an optimal alternative for the reconstruction of the serious tissue defect of ontralateral leg or foot because of no microvascular anastomosis necessary, low vascular crisis risk, and high survival rate.
ObjectiveTo explore the feasibility and effectiveness of V-Y advanced sense-remained posterior tibial artery perforator flap in repairing wound around the ankle. MethodsBetween March 2012 and January 2015, 11 patients with wounds around the ankle were treated by V-Y advanced sense-remained posterior tibial artery perforator flap. There were 6 males and 5 females with a median age of 37 years (range, 21-56 years). The causes were traffic accident injury in 3 cases, thermal injury in 2 cases, burn in 2 cases, iatrogenic wounds in 2 cases, and local contusion in 2 cases. The disease duration ranged from 1 to 3 weeks (mean, 2 weeks). Injury was located at the medial malleolus in 4 cases, at the lateral malleolus in 3 cases, and at the heel in 4 cases. All had exposure of bone, tendon, or plate. The defect area ranged from 4 cm×2 cm to 5 cm×3 cm; the area of the flap ranged from 11 cm×4 cm to 15 cm×6 cm. ResultsNecrosis of distal flap occurred in 1 case after operation; re-operation to amputate the posterior tibial artery was given and the wound was repaired by proximal skin graft. Light necrosis of distal end was observed in 2 cases, and wound healed at 3 weeks after dressing. And other flaps successfully survived, and primary healing of wounds were obtained. The patients were followed up 6-24 months (mean, 11 months). The flaps were good in color, texture, and appearance. The ankle joint had normal activity. At last follow-up, 10 cases restored fine sense, and 1 case restored protective feeling with posterior tibial artery advanced flap after amputation. ConclusionV-Y advanced sense-remained posterior tibial artery perforator flap has the advantages of reliable blood supply, simple operation, good appearance, and sensory recovery. Therefore, it is an ideal method to repair wound around the ankle.