小腿内侧皮瓣在修复口底癌术后缺损中的应用

目的 研究小腿内侧皮瓣在口底癌术后缺损修复中的应用.方法 应用该修复方法,共进行了5例口底癌术后缺损的修复,并对该皮瓣的应用解剖,制作技术及其优缺点进行了讨论.结果 7侧小腿内侧皮瓣均获得成功.口内外伤口均愈合良好,取得了良好的修复效果.覆盖于小腿内侧皮肤缺损区的皮片全部成活.结论 小腿内侧皮瓣适用于口底癌术后组织缺损的修复.对于口腔颌面部肿瘤术后的软组织缺损可利用携带部分比目鱼肌的小腿内侧皮瓣修复软组织缺损.小腿内侧游离皮瓣的皮下脂肪薄,皮瓣较柔软且远离术区,术后供区隐蔽,损伤小.     

足背动脉内侧筋膜支为蒂的足内侧皮瓣移植

目的报道足背动脉内侧筋膜支为蒂的足内侧皮瓣的设计及临床应用结果。方法对足内侧区皮肤筋膜血供的进一步观测,发现足背动脉内侧筋膜支恒定,为该区的重要血供来源。据此设计了可达10cm×8cm 的足内侧皮瓣。临床用于修复足背、踝部、前足、小腿下端及手部软组织缺损18例。结果术后皮瓣全部成活,效果良好,供区损害轻。结论足背动脉内侧筋膜分支是足内侧皮瓣的可靠血管蒂。该皮瓣是修复足背、踝部、小腿下端及前足软组织缺损的一种理想的组织瓣。     

Surgical review: the versatile reverse flow sural artery flap for lower 1/3 leg and foot defects: clinical series

Background  

The soft tissue defects of lower third leg, ankle, and foot present a challenging problem because of the paucity of local tissue and poor circulation of skin in that region. Various forms of coverage including muscle flaps, fascial flaps, and free flaps are used for reconstruction. Each have their specific indications and inherent disadvantages. Distally based fasciocutaneous flap supplied by vascular axis around sural nerve is intensively researched and constitutes another important alternative to lower third and foot reconstruction.     

Combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle for reconstruction of complex soft tissue defects in the hand

The reconstruction of complex soft tissue defects in hands remains a difficult challenge in reconstructive surgery. In this report, we introduce a combined medialis pedis and medial plantar fasciocutaneous flaps supplied by the lateral and medial branches of the medial plantar artery, which allows a one-stage reconstruction of multiple soft tissue defects in hand. Three combined medialis pedis and medial plantar fasciocutaneous flaps were transferred for repair of the soft tissue defects including palmar and dorsal areas of hand, thumb pulp, and the dorsum of index finger in three patients. All three flaps survived uneventfully with coverage matching the texture and color of the recipients. The donor sites healed without complication. The experience from these cases proves that the combined medialis pedis and medial plantar fasciocutaneous flaps based on the medial plantar pedicle would be a valuable alternative for the reconstruction of complex soft tissue defects in the hand.     

Distally based sural fasciomyocutaneous flap: Anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel

The reconstruction of the distal third leg and weight‐bearing heel, especially when complicated with infection and/or dead space, remains a challenge in reconstructive surgery. The distally based sural neurofasciomyocutaneous flap has been proved a valuable tool in repair of the soft tissue defects of those areas. In this report, we present the results of the anatomical study on vascular communication between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle and a modified technique in clinical applications for reconstruction of the soft tissue defects in the distal lower leg and heel. Six lower limbs of fresh cadavers were injected with red gelatin and dissected. A constant vascular connection with average four musculo‐fasciocutaneous perforators with diameter 0.2–0.5 mm was identified in the overlapping area between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle. Based on these findings, a modified distally based sural neurofasciomyocutaneous flap including the distal gastrocnemius muscle component was designed and used for repairs of the soft tissue defects in the distal lower limb and plantar heel pad in six patients. The blood supplies of flaps comprised either the peroneal perforator and adipofascial pedicle or the peroneal perforator only. The average size of the fasciocutaneous flap was 51 cm², and the muscle component 17.7 cm². All flaps survived uneventfully. Our results suggest that this technical modification could provide wider range for applications of the distally based sural neurofasciomyocutaneous flap in repair of the soft tissue defects of the lower extremity and heel. © 2008 Wiley‐Liss, Inc. Microsurgery, 2009.     

足背动脉内侧筋膜支为蒂的足内侧皮瓣移植

目的报道足背动脉内侧筋膜支为蒂的足内侧皮瓣的设计及临床应用结果。方法对足内侧区皮肤筋膜血供的进一步观测,发现足背动脉内侧筋膜支恒定,为该区的重要血供来源。据此设计了可达１０ｃｍ×８ｃｍ的足内侧皮瓣。临床用于修复足背、踝部、前足、小腿下端及手部软组织缺损１８例。结果术后皮瓣全部成活,效果良好,供区损害轻。结论足背动脉内侧筋膜分支是足内侧皮瓣的可靠血管蒂。该皮瓣是修复足背、踝部、小腿下端及前足软组织缺损的一种理想的组织瓣。     

足背动脉内侧筋膜支为蒂的足内侧皮瓣移植

目的 报道足痛动脉内侧筋膜支为蒂的足内侧皮瓣的设计及临床应用结果。方法 对足内侧区皮肤筋膜血供的进一步观测,发现足背动脉内侧筋膜支恒定,为该区的重要血供来源。据此设计了可达１０ｃｍ×８ｃｍ的足内侧皮瓣。临床用于修复足背、踝部、前足、小腿下端及手部软组织缺损１８例。结果 术后皮瓣全部成活,效果良好,供区损害轻。结论 足背动脉内侧筋膜分支是足内侧皮瓣的可靠血管蒂。该皮瓣是修复足背、踝部、小腿下端及前足     

Fasciocutaneous flaps for lower extremity wounds

The use of fasciocutaneous flaps to cover soft tissue defects of the lower leg following trauma, is discussed in this article. Our experience with 15 cases is presented. There have been no complications. We feel that fasciocutaneous flaps are a safe and reliable method for the management of difficult wounds of the lower leg.     

Sural artery flap: a dependable solution in lower leg and foot soft tissue reconstruction

For a variety of reasons, mainly anatomical, the skin and soft tissue defects in the lower leg and foot remain a challenging problem for reconstructive surgeons. Simple skin grafts, local random flaps, cross leg flaps, microvascular flaps, etc., have been used to tackle this difficult problem. Although to date, probably the most popular flaps are the fasciocutaneous flaps based on one of the three major vessels of the leg. We have used a fasciocutaneous flap based on sural artery, accompanying the sural nerve to cover moderate-sized defects in 12 cases. This eliminates the sacrifice of major vessels, and the procedure is easy, quick, and dependable.     

腓肠浅动脉逆行岛状筋膜皮瓣急诊修复下肢创伤性皮肤软组织缺损

目的探讨急诊一期修复小腿中下段及足部创伤性软组织缺损的方法. 方法 2000年2月～2003年12月,应用同侧腓肠浅动脉逆行岛状筋膜皮瓣急诊一期修复小腿及足部皮肤软组织缺损18例,并分析其可行性及手术注意点;切取皮瓣4 cm×5 cm～11 cm×12 cm. 结果除2例皮瓣远端1/3发绀并坏死经换药Ⅱ期愈合外,其余皮瓣均Ⅰ期愈合.随访1～2年,有2例皮瓣臃肿,其余外观满意,功能均恢复正常. 结论腓肠浅动脉逆行岛状筋膜皮瓣急诊修复创伤性皮肤软组织缺损,具有早期闭合创面、促进早期功能锻炼的优点,尤其适合于急诊修复小腿下1/3及其足踝部的皮肤软组织缺损.     

腓肠神经营养血管复合皮瓣一期修复跟腱区软组织缺损并感染

目的探讨应用腓肠神经营养血管远端蒂肌腱筋膜复合皮瓣修复跟腱区复杂软组织缺损并感染的手术方法和临床疗效。方法回顾性分析我科白2005年7月至2011年11月收治的13例跟腱区复杂软组织缺损患者的临床资料,其中男10例,女3例;年龄11～41岁,平均19岁;皮瓣面积14cm×8cm～18cm×10cm,均采用腓肠神经营养血管远端蒂肌腱筋膜复合皮瓣一期覆盖创面并修复跟腱缺损。结果随访2个月～2年,13例皮瓣术后均全部成活,2例皮瓣蒂部浅层坏死,4例皮瓣远端边缘散在浅层坏死,均经短期换药后愈合,患踝及小腿外形满意,提踵有力,踝关节功能基本正常,负重及行走不痛,无跛行,AOFAS评分88分,根据ArnerLindholm评定标准进行疗效评价,优9例,良4例,优良率100％。结论腓肠神经营养血管远端蒂肌腱筋膜复合皮瓣血供可靠,操作简单,能够在修复创面的同时修复重建跟腱的连续性和功能,是修复跟腱区复杂软组织缺损的理想方法。     

改良小腿内侧筋膜蒂皮瓣的临床应用和筋膜蒂位置分区的研究

目的 讨论在小腿不同分区内改良小腿内侧筋膜蒂皮瓣的设计及临床效果. 方法 自2005年1月至2008年2月,将小腿均分为三个区,按皮瓣筋膜蒂位置的分区不同分别采用逆行或顺行的改良小腿内侧筋膜蒂皮瓣修复膝前、小腿及足踝部软组织缺损45例.皮瓣面积最大25.0 cm×10.0cm,最小5.0 cm×3.0 cm. 结果 43例皮瓣完全成活,创面一期愈合;小腿上1/3内有2例皮瓣远端部分坏死,经换药后愈合.术后随访4～20个月,皮瓣颜色及质地好,外形及功能恢复满意. 结论 改良小腿内侧筋膜蒂皮瓣设计灵活、切取简单,不牺牲主干血管,血供可靠,可根据皮瓣筋膜蒂位置的不同选择合适皮瓣,是一种修复下肢软组织缺损的理想皮瓣.     

Veno-accompanying artery fasciocutaneous flaps following wide excision of soft tissue tumors in the lower legs

BackgroundSoft tissue defects following wide excision of malignant soft tissue tumors (STTs) are sometimes too large for primary closure, especially in the lower legs where available soft tissue is limited. This study aimed to determine the clinical outcomes of reconstruction of a defect after wide excision of an STT with a veno-accompanying artery fasciocutaneous (VAF) flap in the lower leg.MethodsThis study comprised 9 patients with malignant STTs who had undergone reconstructive surgeries using VAF flaps after wide excisions, between October 2010 and September 2017. We retrospectively reviewed and collected data involving age, sex, follow-up period, histological diagnosis, surgical procedures, size and location of defects, size and location of the flaps, venous source of the flaps, direction of the pedicles, closing of donor sites, perioperative chemotherapies, postoperative complications, and the presence of postoperative local recurrence and metastasis.ResultsThe median follow-up period was 91.5 (range, 15.5–189.0) months. Four patients had defects located around the knee, 3 patients had defects located on the calf, and 2 patients had defects located around the ankle. The mean flap size was 95.6 × 119.4 (range, 50 × 100–130 × 140) mm. Six patients had venous sources from the small saphenous vein and 3 patients had venous sources from the great saphenous vein. The pedicles were proximally based in 4 patients and distally based in 5 patients. All flaps remained viable without any complications.ConclusionsOur findings showed that the VAF flap was easily elevated and reliable. Furthermore, it was effective in reconstructing soft tissue defects following wide excisions of STTs in the lower leg.     

A simple way to secure the distally based fascio-cutaneous flap of the leg: the lesser sapheneous-greater sapheneous vein anastomosis. Report of 15 clinical cases

PURPOSE: The distally based fasciocutaneous flaps of the leg are very useful for the treatment of skin defects at the lower third of the leg and the foot, but the venous congestion due to the reverse flow can be responsible of necrosis at the distal part of the flap. The anastomosis of the lesser saphenous vein which is included in the flap's dissection to the greater saphenous vein near the defect avoid this venous congestion and the necrosis of the most useful part of the flap for the coverage of these defects. MATERIAL AND METHODS: From January 1999 to June 2005, 15 patients aged between 22 and 64 years old have benefited for the treatment of soft tissue defects secondary to trauma with a mean diameter of 7 x 10 cm and located in 7 cases at the lower third of the leg and in 8 cases at the posterior side of the heel, from distally based posterior fasciocutaneous flaps where the venous reverse flow has been changed in a physiological one by the terminolateral anastomosis between the lesser and greater saphenous vein. The dissection of these flaps was classical except that the lesser saphenous vein was dissected 6 cm beyond the proximal part of the flap in the popliteal region. RESULTS: In all these flaps, there was no venous congestion and no arterial problems. With a mean follow-up of 40 months, the coverage's quality of these defects was very satisfactory. No sequellae are reported. CONCLUSION: The anastomosis between the lesser and the greater saphenous veins seems to eliminate the main source of failure of the distally based fasciocutaneous flap of the leg and can reinforce the indications of these flaps for the treatment of such defects.     

Experience with the distally based posterior tibial island flap

A series of ten patients is presented to demonstrate the use of the distally based posterior tibial island flap with or without a muscle component for reconstruction of the foot. Six patients had defects due to a road traffic accident, two had defects due to a work accident, one had extensive scar contractures after a deep burn and advanced Buerger’s disease in another. There was complete survival of all the flaps but one. Four flaps were fasciocutaneous and six myofasciocutaneous, including the medial hemisoleus muscle. This flap is very useful in lower extremity reconstruction, particularly in the lower third of the leg and foot due to its long vascular pedicle, availability of skin and muscle and ease of elevation. All the island flaps were based on the anastomosis between posterior tibial and peroneal arteries above the medial malleolus. Received: 16 December 1997 / Accepted: 1 July 1998     

Experience with the distally based sural neurofasciocutaneous flap supplied by the terminal perforator of peroneal vessels for ankle and foot reconstruction

The distally based sural fasciocutaneous flap has been proved an excellent option for coverage of the soft tissue defects of the lower third of the leg, ankle, and foot. In this article, we reported on a series of foot and ankle reconstructions with a distally based sural neurofasciocutaneous flap supplied by the terminal perforating branch of the peroneal artery. The vascular pedicle of the flap includes the terminal perforator branch of the peroneal artery and concomitant veins. The pivot point is approximately 5 cm above the tip of lateral malleolus. Fifteen patients with soft tissue defects of the foot and/or ankle underwent the procedures of reconstruction. The flaps were designed with the size measuring 8 x 9 cm to 13 x 31 cm. Thirteen flaps survived completely and 2 with partial or margin necrosis. Our experience has demonstrated that this sural flap with a thin perforator pedicle can be easily rotated, used for coverage of a large tissue defect including the forefoot area, and provide a good texture match and contour for the recipient area.     

Thirteen-Year Follow-Up Reverse Sural Artery Flap for Plantar Calcaneal Wound: A Case Report

Reconstruction of soft tissue defects in the lower leg and foot after traumatic injury is a challenging problem owing to lack of locally reliable flaps. The traditional options for wound coverage often do not provide feasible or adequate treatment for many of these wounds. The lack of skin laxity in the lower leg and foot often make local flaps unavailable. Split-thickness skin grafts will not be robust enough. Free tissue flaps have a litany of potential complications and guaranteed comorbidities. The present case reinforces that appropriately selected patients with significant open bony and soft tissue trauma to the foot and ankle can be treated with a reverse sural artery fasciocutaneous flap. The reverse sural artery flap allows for full-thickness skin coverage with its own blood supply, maximizing the healing potential and should be considered a viable first option for soft tissue coverage.     

Heel Coverage Using a Distally Based Sural Artery Fasciocutaneous Cross-leg Flap: Report of a Small Series

One of the goals in the management of severe open injuries of the foot is to obtain adequate soft tissue coverage. In extreme conditions of pedal soft tissue loss, in patients who are not satisfactory candidates for local or free-tissue transfer, the cross-leg flap remains an option for surgical reconstruction. We present the results of 7 patients with multiple lower limb open fractures associated with ipsilateral degloving injuries, and/or secondary pressure ulcers of the hindfoot with exposure of the calcaneus, in which a distally based sural artery island fasciocutaneous flap, elevated from the contralateral leg and crossed to the injured side, was used to repair the soft tissue defect of the recipient heel. All of the flaps survived and the soft tissues healed uneventfully, thereby providing satisfactory and stable coverage of the calcaneal tuberosity. To the best of our knowledge, this is the first report in which this technique has been used to repair hindfoot soft tissue defects associated with complex bone and vascular injuries of the lower limb in polytrauma patients. Level of Clinical Evidence: 4.     

桥式交叉逆行股前外侧皮瓣转移修复对侧小腿中下段软组织缺损

目的 报道以桥式交叉逆行股前外侧皮瓣转移修复对侧小腿软组织缺损的方法和效果.方法 对于小腿中下段皮肤软组织缺损伴对侧小腿软组织损伤或胫后动脉破坏5例,采用对侧逆行股前外侧皮瓣桥式交叉转移予以修复. 结果 术后皮瓣血运良好,6周后断蒂,皮瓣均存活.术后随访12～15个月,皮瓣质地优良、外形美观,伴骨骼、肌腱缺损者均顺利完成二期修复手术.供区愈合良好,供侧肢体无明显影响. 结论 对于小腿中下段较大面积皮肤软组织缺损伴周围软组织受损,且对侧小腿血管质量不佳的病例,以对侧逆行股前外侧皮瓣桥式交叉转移修复是一种优良的手段.