Livingston, United Kingdom From the Department of Plastic Surgery, St. John's Hospital at Howden.
Plast Reconstr Surg. 2010 Jun;125(6):1735-1743. doi: 10.1097/PRS.0b013e3181ccdc08.
The islanded propeller-design posterior tibial artery perforator flap is a versatile local reconstructive option for defects of the lower leg, ankle, heel, and foot.
A retrospective review of patients undergoing this procedure from 1989 to 2009 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes.
One-hundred six flaps were islanded on a single perforator from the posterior tibial artery in 100 patients (six bilateral). Seventy-two percent of defects were at the lower third of the leg, and 10 percent were at the ankle, heel, or foot. The median angle of rotation about the perforator was 160 degrees (range, 60 to 180 degrees). Eighty-eight percent of flaps had associated fractures, 60 percent were managed using intramedullary nailing, and 44 percent were Gustilo grade IIIb fractures. Five percent of patients subsequently developed osteomyelitis, and the primary nonunion rate was 9 percent. There was an 8.5 percent complete and 12 percent partial flap failure rate, both associated with cigarette smoking, diabetes, and peripheral vascular disease. Limb salvage for complete flap failures included free muscle flap transfer in six cases and below-knee amputation in three cases.
The islanded propeller-design posterior tibial artery perforator flap provides reliable coverage of lower limb defects, particularly of the lower third.
游离桨式腓动脉皮瓣是小腿、踝、跟和足部缺损的一种多用途的局部重建选择。
对 1989 年至 2009 年期间接受该手术的患者进行回顾性研究。对病历进行分析，以确定人口统计学和围手术期因素、并发症和结果。
100 名患者（6 例双侧）中有 100 例在腓动脉单一穿支上游离出 106 个皮瓣。72%的缺损位于小腿下段，10%位于踝、跟或足部。穿支旋转的中位数角度为 160 度（范围为 60 度至 180 度）。88%的皮瓣有合并骨折，60%采用髓内钉固定，44%为 Gustilo Ⅲb 型骨折。5%的患者随后发生骨髓炎，9%的患者出现原发性骨不连。完全皮瓣失败的发生率为 8.5%，部分皮瓣失败的发生率为 12%，两者均与吸烟、糖尿病和周围血管疾病有关。对于完全皮瓣失败的患者，包括 6 例游离肌肉皮瓣转移和 3 例膝下截肢。
游离桨式腓动脉皮瓣能可靠地覆盖下肢缺损，特别是小腿下段的缺损。
