Bibbo Christopher, Dubin Jeremy, Patel Deepak V
Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, MD.
Ann Plast Surg. 2025 Jul 1;95(1):76-80. doi: 10.1097/SAP.0000000000004376.
The use of free tissue transfers has overshadowed the much simpler approach of using simpler local rotation flaps for soft tissue coverage, especially in the foot and ankle. In this study, the authors aimed to examine the results of a single surgeon experience (CB) of the distally based reverse peroneus brevis muscle flap as the first line flap coverage for soft tissue coverage of the foot and ankle in medically high-risk patients who would otherwise require a major amputation.
All patients underwent Doppler examination only, prior to and intraoperatively prior to elevation of the distally based (reverse) peroneus brevis muscle flap; formal angiography or CT angiogram was not performed. The number of muscular perforators was documented intraoperatively as well as the defect size and location of flap inset. Patient demographics, medical risk factors for limb loss, mechanism of injury, the presence of soft tissue or bone infection, and wound size were recorded. The number of flap muscular perforators, flap complications, and donor site morbidity were recorded.
Complete flap survival was observed in 75% of patients, while 14% experienced partial flap necrosis. Minor donor site morbidity was seen in 11% of patients. Complete flap necrosis occurred in 11% of patients. Smoking demonstrated to a statistically significant influence for partial/full flap failure (P = 0.0383, Fisher's exact test). Additionally, among patients with diabetes, an abnormally elevated hemoglobin A1c, which was defined as ≥6.5, consistent with the standard for uncontrolled diabetes, demonstrated a statistical association for a flap-related complication (P = 0.0170, Fisher's exact test). Overall, at a mean follow-up of 6.9 years, an 83% limb salvage rate was achieved. Failed limb salvage resulting in amputation was not necessarily due solely to a flap complication.
These data demonstrate that the distally-based reverse peroneus brevis muscle flap may be considered as a first line option for foot and ankle soft tissue coverage in the high-risk, multimorbid patient who is otherwise facing a major level amputation. The novelty lies in the patient population examined, specifically, high-risk, multimorbid patients with medium or large-sized soft tissue defects of the lower leg, foot and ankle.
游离组织移植的应用使使用更简单的局部旋转皮瓣进行软组织覆盖这种更为简便的方法黯然失色，尤其是在足踝部。在本研究中，作者旨在探讨由单一外科医生（CB）采用以远侧为蒂的腓骨短肌逆行肌皮瓣作为一线皮瓣覆盖物，用于足踝部软组织覆盖的结果，这些医学高风险患者若不采用该方法则可能需要进行大截肢。
所有患者在掀起以远侧为蒂（逆行）的腓骨短肌皮瓣之前，仅在术前和术中进行多普勒检查；未进行正式的血管造影或CT血管造影。术中记录肌肉穿支数量以及皮瓣植入部位的缺损大小和位置。记录患者的人口统计学资料、肢体丧失的医学风险因素、损伤机制、软组织或骨感染的存在情况以及伤口大小。记录皮瓣肌肉穿支数量、皮瓣并发症和供区并发症。
75%的患者皮瓣完全存活，14%的患者出现部分皮瓣坏死。11%的患者出现轻微的供区并发症。11%的患者皮瓣完全坏死。吸烟对部分/完全皮瓣失败有统计学显著影响（P = 0.0383，Fisher精确检验）。此外，在糖尿病患者中，糖化血红蛋白A1c异常升高（定义为≥6.5，符合未控制糖尿病的标准）与皮瓣相关并发症有统计学关联（P = 0.0170，Fisher精确检验）。总体而言，平均随访6.9年时，肢体挽救率达到83%。导致截肢的肢体挽救失败不一定完全归因于皮瓣并发症。
这些数据表明，对于面临大截肢的高风险、多种疾病并存的患者，以远侧为蒂的腓骨短肌逆行肌皮瓣可被视为足踝部软组织覆盖的一线选择。本研究的新颖之处在于所研究的患者群体，具体为患有小腿、足和踝部中大型软组织缺损的高风险、多种疾病并存的患者。
