Li Shi-Ji, Cheng Hao, Fang Xu, Xu Jian-Yang, Wang Fei, Liu Sheng, Chen Xu-Lin, Lv Xiong-Wen
Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
Burns. 2017 Jun;43(4):839-845. doi: 10.1016/j.burns.2016.12.003. Epub 2016 Dec 30.
Challenges persist in the reconstruction of the ankle and the foot with exposed tendons, joints, and bones as a result of severe burns and trauma. In flap elevation involving the sensitive superficial nerve, the local nerve was always sacrificed to obtain an anesthetic donor site; however, such a procedure introduced the possibility of painful neuromas. In this study, we present a desired clinical application of a modified reversed superficial peroneal artery flap, in which the superficial peroneal nerve is preserved.
From 2008 to 2015, 12 patients with ankle or foot defects were treated with the modified reversed superficial peroneal artery flap. The defects of the patients were caused by hot liquid scald (one patient), electrical injury (five patients), and trauma (six patients). The flap was utilized for covering defects on the ankle (seven patients) and the foot (five patients). The size of the flaps ranged from 4.0cm×6.0cm to 18.0cm×10.0cm. The superficial peroneal artery was involved in the flap, whereas the superficial peroneal nerve was spared by dedicate dissection. The reverse-flow flap was nourished by the superficial peroneal artery through the terminal peroneal artery perforator.
The obtained outcomes were satisfactory functionally and aesthetically. The flaps in 11 patients survived completely without complications, whereas partial necrosis occurred in a 78-year-old patient when the flap survived a week later during follow up. CT angiography revealed the stenosis of the popliteal artery. The wound healed after interventional treatment involving placing a stent and changing the dressings. Basic functions and configurations were salvaged in all cases. All patients were completely satisfied with the proposed flap and suffered no paresthesia in their lower leg.
Exhibiting beneficial characteristics such as reliable blood supply, favorable thickness, wide rotating arc, and retention of major vessels and the superficial peroneal nerve, the modified reversed superficial peroneal artery flap is useful in the reconstruction of ankle and foot defects that would not cause any hypoesthesia of the foot.
由于严重烧伤和创伤导致踝关节和足部出现肌腱、关节和骨骼外露，其重建工作仍面临诸多挑战。在涉及敏感浅表神经的皮瓣掀起过程中，为获得麻醉供区，局部神经常被牺牲；然而，这样的操作会引发疼痛性神经瘤的可能性。在本研究中，我们展示了一种改良的逆行腓浅动脉皮瓣的理想临床应用，其中保留了腓浅神经。
2008年至2015年，12例踝关节或足部缺损患者接受了改良逆行腓浅动脉皮瓣治疗。患者的缺损由热液烫伤（1例）、电击伤（5例）和创伤（6例）引起。皮瓣用于覆盖踝关节（7例）和足部（5例）的缺损。皮瓣大小从4.0cm×6.0cm到18.0cm×10.0cm不等。腓浅动脉包含在皮瓣内，而腓浅神经通过专门的解剖得以保留。反流皮瓣由腓浅动脉通过终末腓动脉穿支供血。
获得了功能和美学上均令人满意的结果。11例患者的皮瓣完全存活且无并发症，而1例78岁患者在随访1周后皮瓣存活，但出现了部分坏死。CT血管造影显示腘动脉狭窄。经放置支架和更换敷料的介入治疗后伤口愈合。所有病例均挽救了基本功能和外形。所有患者对所提议的皮瓣完全满意，小腿均无感觉异常。
改良逆行腓浅动脉皮瓣具有血供可靠、厚度适宜、旋转弧宽以及保留主要血管和腓浅神经等有益特性，可用于重建踝关节和足部缺损，且不会导致足部任何感觉减退。
