Repair of soft tissue defect of dorsal foot in adults using uperficial circumflex iliac artery perforator superthin flaps

doi:10.3969/j.issn.1009-976X.2020.03.013

Abstract

Abstract: Objective To analyze the clinical effect of uperficial circumflex iliac artery perforator superthin flaps in repair of soft tissue defect of dorsal foot in adults. Methods The clinical data of 19 cases of soft tissue defect of dorsal foot with bone or tendon exposure from 2014 to 2017 in the Affiliated Hospital of Binzhou Medical College were analyzed retrospectively,the soft tissue defect was repaired by uperficial circumflex iliac artery perforator superthin flap, primary or secondary defect repair,and the donor area was sutured directly. Results All the patients were followed up for an average of 1~5 years, and the soft tissue defect of dorsal foot was repaired effectively. 3 cases had local necrosis of 0.5~1 cm flap edge. After the necrosis boundary was cleared, the flap healed well through suturing again. 1 case had blood stasis under the flap, swelling of the flap, but the flap survived through intermittent suture removal, removal of congestion and full drainage. 1 case presented with arterial crisis, which emergency operation was performed. The embolus with a length of about 0.5 cm was found by exploration. The embolus was removed and the artery was anastomosed again, and the flap survived well.The skin flap was beautiful in appearance, soft in texture and suitable in thickness. At the last follow-up, the AOFAS ankle posterior foot score was （91.02 ± 1.74）, the function was excellent in 14 cases （74%）, good in 4 cases （21%）. The excellent and good rate of AOFAS was 95%, and the function of affected limb recovered well. Conclusion The uperficial circumflex iliac artery perforator superthin flap can be used to repair the soft tissue defect of dorsal foot in adults. The skin flap is beautiful in appearance, soft in texture and suitable in thickness, which can achieve good clinical effect.

Key words: soft tissue defect of dorsal foot, perforator flap, uperficial circumflex iliac artery perforator, free flap

摘要： 目的分析显微削薄旋髂浅动脉穿支皮瓣修复成人足背侧创面的临床效果。方法回顾性分析2014年至2017年滨州医学院附属医院收治的19例伴有骨骼或肌腱外露的足背侧创面患者的临床资料,均通过显微削薄旋髂浅动脉穿支皮瓣,一期或二期修复创面,供区直接缝合。结果所有患者均获得随访,平均随访1~5年,足背侧创面获得了有效修复;3例出现局部0.5~1 cm皮瓣边缘坏死,待坏死界线清楚以后切除坏死皮瓣,经重新缝合以后皮瓣愈合良好;1例出现皮瓣下方淤血,皮瓣肿胀,经间断拆线,清理淤血并充分引流以后皮瓣成活;1例出现动脉危象,给予急症手术,探查发现动脉吻合口长度约0.5 cm栓子,取出栓子并重新吻合动脉,皮瓣最终成活良好;足部外形美观,皮瓣柔软,厚薄适中;末次随访时AOFAS踝-后足评分为（91.02±1.74）,功能为优者14例（74%）,良者4例（21%）,AOFAS评分优良率95%,患肢功能恢复良好。结论应用显微削薄旋髂浅动脉穿支皮瓣修复成人足背侧创面,皮瓣外形美观,质地柔软,厚薄适中,可达到良好的临床效果。

关键词: 穿支皮瓣, 旋髂浅动脉穿支, 足背侧创面, 游离皮瓣

CLC Number:

R628

FU Bing-jin, YANG Jia-lin, DENG Ming-ming, DU Rui, SUN Guang-chao, YIN Gang. Repair of soft tissue defect of dorsal foot in adults using uperficial circumflex iliac artery perforator superthin flaps[J]. Lingnan Modern Clinics in Surgery, 2020, 20(03): 315-318.

付炳金, 杨佳林, 邓明明, 杜瑞, 孙广超, 尹刚. 显微削薄旋髂浅动脉穿支皮瓣修复成人足背侧创面[J]. 岭南现代临床外科, 2020, 20(03): 315-318.

References

[1] 沈余明. 毁损性创面的修复策略[J]. 中华损伤与修复杂志(电子版), 2019, 14(2): 81-84.
[2] 魏在荣, 王达利, 黄广涛. 毁损性创面的治疗进展[J]. 中华损伤与修复杂志(电子版), 2019, 14(2): 85-90.
[3] Kimura N.A microdissected thin tersor fasciae latae perforator flap[J]. Plast Reconstr Surg, 2002, 109(1): 69-77.
[4] Rajacic N, Gang RK, Krishnan J, et al.Thin anterolateral thigh free flap[J]. Ann Plast Surg, 2002, 48(3): 252-257.
[5] Kimura N, Satoh K, Hosaka Y.Microdissected thin perforator flaps: 46 cases[J]. Plast Reconstr Surg, 2003, 112(7):1875-1885.
[6] Yang WG, Chiang YC, Wei FC, et al.Thin anterolateral thigh perforator flap using a modified perforator microdissection technique and its clinical application for foot resurfacing[J]. Plast Reconstr Surg, 2006, 117(3): 1004-1008.
[7] Chen YC, Scaglioni MF, Carrillo Jimenez LE, et al.Suprafascial anterolateral thigh flap harvest: A Better way to minimize donor-site morbidity in head and neck reconstruction[J]. Plast Reconstr Surg, 2016, 138(3): 689-698.
[8] Hallock GG.Further clarification of the nomenclature for compound flaps[J]. Plast Reconstr Surg, 2006, 117(7): 151-160.
[9] Hallock GG.An introduction to the chimeric deep inferior epigastric artery perforator (DIEAP)-rectus abdominis muscle flap[J]. Ann Plast Surg, 2008, 61(5): 580-583.
[10] Goh TL, Park SW, Cho JY, et al.The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap-A review of 210 cases[J]. Plast Reconstr Surg, 2015, 135(2): 592-601.
[11] Koshima I, Nanba Y, Tsutsui T, et al.Superficial circumflex iliac artery perforator flap for reconstruction of limb defects[J]. Plast Reconstr Surg, 2004, 113(1): 233-240.
[12] Hsu WM, Chao WN, Yang C, et al.Evolution of the free groin flap: the superficial circumflex iliac artery perforator flap[J]. Plast Reconstr Surg, 2007, 119(5): 1491-1498.
[13] Feng S, Xi W, Zhang Z, et al.A reappraisal of the surgical planning of the superficial circumflex iliac artery perforator flap[J]. J Plast Reconstr Aesthet Surg, 2017, 70(4): 469-477.
[14] Hallock GG.Doppler sonography and color duplex imaging for planning a perforator flap[J].Clin Plast Surg, 2003, 30(3): 347-357.
[15] Stupp T, Pavlidis M, Busse H, Thanos S.Presurgical and postsurgical ultrasound assessment of lacrimal drainage dysfunction[J]. Am J Ophthalmol, 2004, 138(5): 764-771.
[16] Lethaus B, Loberg C, Kloss-Brandst?tter A, et al. Color duplex ultrasonography versus handheld Doppler to plan anterior lateral thigh flaps[J]. Microsurgery, 2017, 37(5): 388-393.
[17] Su W, Lu L, Lazzeri D, et al.Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning[J]. Plast Reconstr Surg, 2013, 131(1): 80-93.
[18] Tan H, Yang K, Wei P, et al.A novel preoperative planning technique using a combination of ct angiography and three-dimensional printing for complex toe-to-hand reconstruction[J]. J Reconstr Microsurg, 2015, 31(5): 369-377.
[19] Kimura N, Saito M, Itoh Y, et al.Giant combined microdissected thin thigh perforator flap[J]. Plast Reconstr Aesthet Surg, 2006, 59(12): 1325-1329.
[20] Tsai FC, Yang JY, Mardini S, et al.Free split- cutaneous perforator flaps procured using a three- dimensional harvest technique for the reconstruction of postburn contracture defects[J]. Plast Reconstr Surg, 2004, 113(1): 185-195.
[21] Kim KN, Hong JP, Park CR, et al.Modification of the elevation plane and defatting technique to create a thin thoracodorsal artery perforator flap[J]. J Reconstr Microsurg, 2016, 32(2):142-146.
[22] Prasetyono TO, Bangun K, Buchari FB, et al.Practical considerations for perforator flap thinning procedures revisited[J]. Arch Plast Surg, 2014, 41(6): 693-701.
[23] 何智灵, 王超, 郭朝剑, 等. 旋髂浅动脉穿支游离皮瓣修复小儿足背皮肤软组织缺损[J]. 中国美容医学, 2019, 28(1): 28-30.