Hashmi Pervaiz Mehmood, Ahmed Kamran, Ali Muhammad, Musaddiq Abeer, Hashmi Alizah, Nawaz Zohaib
Aga Khan, University hospital, Karachi, Pakistan.
Indus Hospital, Karachi, Pakistan.
Ann Med Surg (Lond). 2021 Oct 22;71:102916. doi: 10.1016/j.amsu.2021.102916. eCollection 2021 Nov.
To determine the anatomical basis of supramalleolar flap; retrograde versus antegrade and its clinical outcome based on the vascular pattern.
This analytic cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients who underwent coverage of soft tissue defects around the foot and ankle with supramalleolar flaps were included. Data collection was through medical records including demographic parameters, mechanism of injury, per-operative findings of perforator origin, and patient interviewing for final assessment. Patients with peripheral vascular disease, unavailability of skin, and radiation injuries were excluded. All analysis was done using SPSS version 25.0.
49 patients were included in the study from May 1999 to December 2020. The male to female ratio was 37:12. The cause of soft tissue defects was trauma in 9 (38.7%) followed by Infection in 16 (32.6%) and Blast injury in 5 cases (10.2%). The maximum flap size harvested was 20 × 8 cm. In 19 cases the peroneal artery perforator was absent and the flap was based on the perforator of an anterolateral malleolar branch (antegrade) while the remaining 30 flaps were based on the perforator of the peroneal artery (retrograde Overall, the flap survival rate was 98%; as 1 case had partial necrosis and required skin grafting. However, there were 9 minor complications. In 8 patients, the flap was rotated as a . All patients had satisfactory functional outcomes without significant morbidity of the donor site.
The lateral supramalleolar flap provided coverage to almost all regions of the foot and ankle with a cosmetically acceptable donor and recipient site. There were no problems with shoe wear, as only 2 patients required defatting for cosmetic reasons. Microvascular expertise was required for a predictable outcome.
基于血管模式确定外踝上皮瓣逆行与顺行的解剖学基础及其临床疗效。
本分析性横断面研究在巴基斯坦卡拉奇的一家三级护理医院进行。纳入采用外踝上皮瓣覆盖足踝周围软组织缺损的患者。通过病历收集数据，包括人口统计学参数、损伤机制、穿支起源的术中发现，并通过患者访谈进行最终评估。排除患有外周血管疾病、皮肤不可用和放射性损伤的患者。所有分析均使用SPSS 25.0版进行。
1999年5月至2020年12月期间，49例患者纳入本研究。男女比例为37:12。软组织缺损的原因中，创伤9例（38.7%），感染16例（32.6%），爆炸伤5例（10.2%）。收获的最大皮瓣尺寸为20×8cm。19例中腓动脉穿支缺如，皮瓣基于外踝前支穿支（顺行），其余30例皮瓣基于腓动脉穿支（逆行）。总体而言，皮瓣存活率为98%；1例出现部分坏死，需要植皮。然而，有9例轻微并发症。8例患者中，皮瓣作为[此处原文缺失信息]旋转。所有患者功能结局满意，供区无明显并发症。
外踝上皮瓣为足踝几乎所有区域提供覆盖，供区和受区外观均可接受。鞋履穿着无问题，仅2例患者因美容原因需要去脂。为获得可预测的结果，需要微血管专业技术。
