Department of Plastic and Hand Surgery, University of Erlangen Medical Center, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
J Plast Reconstr Aesthet Surg. 2011 May;64(5):656-62. doi: 10.1016/j.bjps.2010.09.013. Epub 2010 Oct 20.
Skin defects of the foot, ankle and distal lower leg often require coverage by local or distant flaps. We aimed to compare functional outcome and donor-site morbidity following transfer of distally based delayed sural (DSFs) or peroneus brevis flaps (PBFs).
Between 2003 and 2006, 52 patients (24 DSFs and 28 PBFs) were included. For increased reliability, all extended sural flaps were delayed for 3-15 days. At the end of the follow-up period (minimum 12 months), patients were asked to fill out a modified foot and ankle score (Foot and Ankle Outcome Score (FAOS)) questionnaire. In addition, a chart review and a physical examination were performed.
Total hospital stay and total number of operations were significantly lower in the PBF group. Minor flap necrosis (<10%) was observed in 21% of the DSF and 7% of the PBF group, and partial (>10%) or total flap loss occurred in one and three patients from the DSF group, respectively. Patient satisfaction, FAOS results and range of motion were comparable in both groups. Defect aetiology and patient age did not influence surgical outcome.
Donor-site morbidity and functional outcome after DSF and PBF are comparable. A higher rate of complications was observed in the DSF group. Based on our findings, the PBF is recommended as first-line procedure for reconstruction of small- to medium-sized defects at the distal tibia, fibula, ankle and heel. The sural flap might be chosen for extended skin defects especially when a larger arc of rotation is required.
足部、踝关节和小腿远端的皮肤缺损通常需要通过局部或远处皮瓣覆盖。我们旨在比较使用远端蒂腓肠神经营养血管皮瓣（DSF）或腓骨短肌皮瓣（PBF）转移后的功能结果和供区发病率。
在 2003 年至 2006 年间，纳入了 52 名患者（24 名 DSF 和 28 名 PBF）。为了提高可靠性，所有的延长腓肠神经营养血管皮瓣均延迟 3-15 天。在随访期结束时（最短 12 个月），患者被要求填写改良足部和踝关节评分（足部和踝关节结局评分（FAOS））问卷。此外，还进行了图表审查和体格检查。
PBF 组的总住院时间和总手术次数明显较低。DSF 组和 PBF 组的轻微皮瓣坏死（<10%）分别为 21%和 7%，DSF 组有 1 名和 3 名患者分别出现部分（>10%）或完全皮瓣丢失。两组患者的满意度、FAOS 结果和活动范围相当。病变病因和患者年龄均未影响手术结果。
DSF 和 PBF 后供区发病率和功能结果相当。DSF 组并发症发生率较高。根据我们的发现，当需要更大的旋转弧时，PBF 被推荐作为胫骨、腓骨、踝关节和足跟小至中等大小缺损重建的首选方法。当需要更大的旋转弧时，腓肠神经营养血管皮瓣可能被选择用于扩展皮肤缺损。
