Li Bo, Chang Shi-Min, Du Shou-Chao, Zhuang Lei, Hu Sun-Jun
From the Department of Orthopedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China.
Ann Plast Surg. 2020 May;84(5):580-587. doi: 10.1097/SAP.0000000000002069.
Distally based perforator propeller flap from the lower leg region is a versatile local reconstructive technique for the foot and ankle defects. However, flap venous congestion remains a tough nut to crack. We hypothesize that raising an adipofascial flap with turnover mode of transposition can improve venous drainage and enhance flap safety.
Based on the 2 rows of septocutaneous perforators in the posterior distal third of the lower leg, distally based adipofascial flap was raised from medial sural region nourished by 1 perforator bundle from the posterior tibial artery or from the lateral sural region from the peroneal artery. The superficial dissection was performed in subdermal plane and deep in to the subfascial space. The flap was nourished by perforator-plus-adipofascial pedicle and turned over 180 degrees upside down to reach the distal wounds. One week later, a split-skin graft was used to cover the exposed fascial flap. Postoperatively, flap survival, complications, and patient functional recovery were evaluated.
Distally based sural turnover adipofascial flaps were used in 12 cases with complicated wounds of the distal third lower leg, foot, and ankle region. All wounds were caused by trauma and experienced fracture implants fixation and 5 with osteomyelitis. The comorbidities include diabetes in 9 cases and smoking in 7. There were 8 medial ural flaps and 4 lateral sural flaps. The adipofiscial flaps measured from 6.0 cm × 5.0 cm to 17.0 cm × 6.0 cm (mean, 61.3 cm). Postoperatively, all flaps survived uneventfully without any complication such as flap ischemia and/or necrosis. Two minor donor site complications were encountered, one was postoperative hematoma, and another was hyperproliferative scar. After a mean of 14.6 months of follow-up, the adipofascial flap plus skin graft showed a durable esthetic coverage, with normal shoe wearing and walking.
Distally based sural adipofascial turnover flap is a simple and reliable wound coverage technique. It avoids venous congestion as usually seen in distally based fasciocutaneous flaps.
小腿远端蒂穿支推进皮瓣是修复足踝部缺损的一种多功能局部重建技术。然而，皮瓣静脉淤血仍然是一个难题。我们推测，采用翻转移位方式掀起脂肪筋膜瓣可改善静脉引流并提高皮瓣安全性。
基于小腿远端后1/3的两排隔皮穿支，从由胫后动脉的1个穿支束供血的小腿内侧区域或由腓动脉供血的小腿外侧区域掀起远端蒂脂肪筋膜瓣。在皮下平面进行浅部剥离，并深入到深筋膜下间隙。皮瓣由穿支加脂肪筋膜蒂供血，并翻转180度倒置以到达远端创面。1周后，用断层皮片覆盖外露的筋膜瓣。术后评估皮瓣存活情况、并发症及患者功能恢复情况。
12例小腿远端、足部和踝部区域复杂创面采用了远端蒂腓肠翻转脂肪筋膜瓣。所有创面均由外伤引起，均经历了骨折内固定，5例合并骨髓炎。合并症包括9例糖尿病和7例吸烟。有8例内侧腓肠皮瓣和4例外侧腓肠皮瓣。脂肪筋膜瓣大小为6.0 cm×5.0 cm至17.0 cm×6.0 cm（平均61.3 cm²）。术后，所有皮瓣均顺利存活，未出现皮瓣缺血和/或坏死等并发症。出现2例轻微供区并发症，1例为术后血肿，另1例为增生性瘢痕。平均随访14.6个月后，脂肪筋膜瓣加植皮显示出持久的美学覆盖效果，穿鞋和行走正常。
远端蒂腓肠脂肪筋膜翻转皮瓣是一种简单可靠的创面覆盖技术。它避免了远端蒂筋膜皮瓣常见的静脉淤血。
