Deng Chengliang, Wu Bihua, Wei Zairong, Li Hai, Zhang Tianhua, Wang Dali
From the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, People's Republic of China.
Ann Plast Surg. 2018 May;80(5):546-552. doi: 10.1097/SAP.0000000000001290.
Peroneal artery perforator flaps are the most widely used pedicled flaps for soft tissue defects of the distal lower extremity. Most research regarding peroneal artery flaps focuses on the location, diameter, and number of peroneal artery perforators. However, there is little literature regarding interperforator flow patterns within the peroneal artery perforator flaps. The aims of the present study were to describe interperforator flow patterns of the distally based extended peroneal artery perforator flaps through digital subtraction angiography and review their clinical application.
Twelve consecutive patients underwent digital subtraction angiography of the lower-limb arteries. The number and classification of peroneal artery perforators and the interperforator flow patterns were observed. Based on these observations, distally based extended peroneal artery perforator flaps were designed to repair nonhealing wounds located on the ankles and feet of 14 patients.
The peroneal artery gives out grades I to IV perforators in the lateral leg. There were 2 to 7 grade I perforators and true anastomoses between adjacent grade II perforators, which generate directly linked vessels in the middle leg. The grade III or IV perforators form a reticular vascular network through a large number of chock and potential anastomoses. All flaps survived and had excellent appearance and texture.
Distally based extended peroneal artery perforator flaps appear reliable for repairing wounds located on or around the ankle and front foot. However, whether the middle perforator or peroneal artery should be used depends on the condition of the anastomosis between direct linking vessels and the distal perforator.
腓动脉穿支皮瓣是治疗下肢远端软组织缺损最常用的带蒂皮瓣。大多数关于腓动脉皮瓣的研究集中在腓动脉穿支的位置、直径和数量上。然而，关于腓动脉穿支皮瓣内穿支间血流模式的文献较少。本研究的目的是通过数字减影血管造影描述远端蒂延长腓动脉穿支皮瓣的穿支间血流模式，并回顾其临床应用。
连续12例患者接受下肢动脉数字减影血管造影。观察腓动脉穿支的数量、分类及穿支间血流模式。基于这些观察结果，设计远端蒂延长腓动脉穿支皮瓣修复14例患者位于踝部和足部的难愈创面。
腓动脉在小腿外侧发出Ⅰ至Ⅳ级穿支。有2至7支Ⅰ级穿支，相邻Ⅱ级穿支之间存在真性吻合，在小腿中部形成直接相连的血管。Ⅲ级或Ⅳ级穿支通过大量吻合支和潜在吻合形成网状血管网。所有皮瓣均存活，外观和质地良好。
远端蒂延长腓动脉穿支皮瓣修复踝部和足前部或其周围的创面似乎可靠。然而，应使用中间穿支还是腓动脉取决于直接相连血管与远端穿支之间的吻合情况。
