Mahmoud Wael Hussein
Lecturer, Plastic and Reconstructive Surgery, Plastic Surgery Department, Tanta Faculty of Medicine, Tanta, Egypt.
J Foot Ankle Surg. 2017 May-Jun;56(3):514-518. doi: 10.1053/j.jfas.2017.01.019. Epub 2017 Feb 28.
Soft tissue defects around the foot and ankle region often present an awkward problem for plastic surgeons. The medial plantar artery flap raised from the non-weightbearing instep of the plantar foot offers a thick, sensorial, durable, and glabrous skin. The reversed sural artery flap offers a reliable option for coverage with the advantages of a wide arc of rotation, adequate dimensions, and a reliable blood supply. The present study compared the outcomes of the medial plantar artery flap and the distally based sural artery flap in foot and ankle reconstruction. The present comparative cross-sectional study included 30 adult patients with soft tissue defects in the foot and around the ankle, who were divided into 2 equal groups. One group underwent reconstruction with the proximally based island medial plantar artery flap (MPAF). The second group underwent reconstruction with the reversed sural artery flap (RSAF). The operative time and complications were carefully recorded. The surgical outcomes in terms of flap survival, durability of coverage, and functional outcome were assessed for all patients. No significant differences were found between the 2 groups in age, sex, etiology, or site of the defect. The defect size was significantly smaller in the MPAF group than in the RSAF group (22 ± 2.7 cm versus 66.2 ± 7.7 cm; p < .001). However, the operative time was significantly longer in the MPAF group than in the RSAF group (100 ± 2.9 minutes versus 80.5 ± 3.1 minutes; p < .001). The flap survived in all cases in the MPAF group, but total flap necrosis occurred in 1 patient in the RSAF group. The mean follow-up period was 13.2 months. Weightbearing was significantly earlier in the MPAF group than in the RSAF group (5.8 ± 0.26 weeks versus 6.9 ± 0.19 weeks; p = .003). None of the 30 patients developed recurrent ulceration. The incidence of complications (33.3% versus 80%) was significantly less in the MPAF group than in the RSAF group (p = .01). Significantly greater improvement was found in the functional outcomes in the MPAF group compared with the RSAF group (p = .004). In conclusion, the MPAF and distally based sural artery flap are the 2 flaps available for foot and ankle reconstruction. However, the MPAF offers better functional outcomes with a lower frequency of postoperative complications. Thus, the sensate MPAF is recommended for reconstruction of moderate-size defects of the foot and ankle region.
足踝部周围的软组织缺损常常给整形外科医生带来棘手的问题。从足底非负重的足背掀起的足底内侧动脉皮瓣可提供厚实、有感觉、耐用且无毛的皮肤。逆行腓肠神经营营皮瓣为创面覆盖提供了可靠的选择，具有旋转弧宽、尺寸合适及血供可靠等优点。本研究比较了足底内侧动脉皮瓣和远端蒂腓肠神经营营皮瓣在足踝部重建中的效果。本项比较性横断面研究纳入了30例足踝部软组织缺损的成年患者，将其平均分为2组。一组采用近端蒂岛状足底内侧动脉皮瓣（MPAF）进行重建。另一组采用逆行腓肠神经营营皮瓣（RSAF）进行重建。仔细记录手术时间和并发症情况。对所有患者评估皮瓣存活、覆盖耐久性及功能结局等手术效果。两组在年龄、性别、病因或缺损部位方面未发现显著差异。MPAF组的缺损大小显著小于RSAF组（22±2.7cm 对比 66.2±7.7cm；p<0.001）。然而，MPAF组的手术时间显著长于RSAF组（100±2.9分钟对比80.5±3.1分钟；p<0.001）。MPAF组所有病例的皮瓣均存活，但RSAF组有1例患者出现皮瓣完全坏死。平均随访期为13.2个月。MPAF组开始负重的时间显著早于RSAF组（5.8±0.26周对比6.9±0.19周；p=0.003）。30例患者均未发生复发性溃疡。MPAF组的并发症发生率（33.3%对比80%）显著低于RSAF组（p=0.01）。与RSAF组相比，MPAF组的功能结局改善更为显著（p=0.004）。总之，MPAF和远端蒂腓肠神经营营皮瓣是可用于足踝部重建的两种皮瓣。然而，MPAF具有更好的功能结局且术后并发症发生率更低。因此，对于足踝部中等大小缺损的重建，建议采用带感觉的MPAF。
