Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Changshun , HU Xiang , ZHENG Qianjin , DUAN Yong , LIU Siyi ,  TAO Shengxiang

Department of Trauma and Micro-orthopedics, Zhongnan Hospital of Wuhan University, Wuhan Hubei, 430071, P.R.China;

Corresponding?author：

TAO Shengxiang, Email: ZN-taoshengxiang@163.com

Keywords：

Posterior tibial artery; composite tissue flap; compound tissue defect; wound repair

DOI：

10.7507/1002-1892.201805093

Video：

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Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years (range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases, tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases. Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.

Citation： CHEN Changshun, HU Xiang, ZHENG Qianjin, DUAN Yong, LIU Siyi, TAO Shengxiang. Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 75-79. doi: 10.7507/1002-1892.201805093 Copy

1.	陶圣祥, 喻愛喜, 余國榮, 等. 腓腸神經營養血管肌皮瓣的解剖與臨床應用. 中華整形外科雜志, 2008, 24(1): 16-19.
2.	唐舉玉, 魏在榮, 張世民, 等. 穿支皮瓣的臨床應用原則專家共識. 中國臨床解剖學雜志, 2016, 34(1): 4-5.
3.	趙治偉, 劉文靜, 查朱青, 等. 帶脛骨隱神經復合組織皮瓣在小腿創傷性骨與皮膚缺損中的臨床應用. 中國骨傷, 2017, 30(12): 1131-1134.
4.	任高宏, 任義軍, 王鋼, 等. 組合皮瓣修復小腿及足踝部大面積軟組織缺損. 中華創傷骨科雜志, 2009, 11(11): 1042-1046.
5.	張文龍, 杜曉健, 李冀, 等. 脛后動脈穿支皮瓣. 中華解剖與臨床雜志, 2017, 22(1): 87-88.
6.	Bista N, Shrestha KM, Bhattachan CL, et al. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities (distal 1/3 leg and foot). Nepal Med Coll J, 2013, 15(1): 56-61.
7.	柳昊, 葉澄宇, 余國榮, 等. 脛后血管蒂小腿內側復合組織瓣的臨床應用. 中國修復重建外科雜志, 2001, 15(3): 147-149.
8.	倪玉龍. 脛骨骨膜瓣的解剖學研究及臨床應用. 唐山: 華北理工大學, 2016.
9.	Hou C, Chang S, Lin J, et al. Posterior tibial artery perforator flap//Surgical atlas of perforator flaps. Netherlands: Springer, 2015: 228-232.
10.	孫文晉, 陶圣祥, 余國榮, 等. 遠端蒂腓淺神經營養血管肌皮瓣的解剖與臨床應用. 中國臨床解剖學雜志, 2012, 30(2): 166-168.
11.	趙風林, 李宗寶, 王鑫, 等. 超薄型脛后動脈穿支皮瓣的解剖學觀察與臨床應用. 中華整形外科雜志, 2013, 29(4): 261-265.
12.	張天華, 魏在榮. 脛后動脈穿支皮瓣的解剖與臨床研究進展. 中國臨床解剖學雜志, 2014, 32(2): 231-233.
13.	Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg, 2008, 122(1): 161-170.
14.	Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg, 2005, 115(3): 793-801.
15.	柴益民, 邱勛永, 林崇正, 等. 脛后動脈穿支隱神經營養血管擬行皮瓣的臨床應用. 中華顯微外科雜志, 2004, 27(2): 99-100.
16.	陶圣祥, 喻愛喜, 鄭曉暉, 等. 隱神經營養血管復合組織瓣的解剖學研究. 中華創傷骨科雜志, 2007, 9(3): 248-250.
17.	黃凱, 郭峭峰, 林炳遠, 等. 脛后動脈穿支蒂螺旋槳皮瓣聯合植骨一期治療脛骨遠端創傷性骨髓炎. 中華顯微外科雜志, 2018, 40(1): 66-68.
18.	馮瓊華, 張遠金, 陶圣祥. 逆行隱神經營養血管肌-皮-骨復合組織瓣轉位術的臨床應用. 中國骨與關節損傷雜志, 2012, 27(9): 862-863.
19.	Sahijwani H, Warikoo V, Salunke AA, et al. Anterior tibial artery perforator plus flaps: Role in coverage of posttumor excision defects around the knee joint and upper leg. Asia Pac J Oncol Nurs, 2017, 4(4): 342-347.
20.	余黎, 余國榮, 陶圣祥, 等. 小腿軟組織缺損合并節段性骨缺損的顯微外科修復. 武漢大學學報 (醫學版), 2012, 33(5): 705-707.

1. 陶圣祥, 喻愛喜, 余國榮, 等. 腓腸神經營養血管肌皮瓣的解剖與臨床應用. 中華整形外科雜志, 2008, 24(1): 16-19.
2. 唐舉玉, 魏在榮, 張世民, 等. 穿支皮瓣的臨床應用原則專家共識. 中國臨床解剖學雜志, 2016, 34(1): 4-5.
3. 趙治偉, 劉文靜, 查朱青, 等. 帶脛骨隱神經復合組織皮瓣在小腿創傷性骨與皮膚缺損中的臨床應用. 中國骨傷, 2017, 30(12): 1131-1134.
4. 任高宏, 任義軍, 王鋼, 等. 組合皮瓣修復小腿及足踝部大面積軟組織缺損. 中華創傷骨科雜志, 2009, 11(11): 1042-1046.
5. 張文龍, 杜曉健, 李冀, 等. 脛后動脈穿支皮瓣. 中華解剖與臨床雜志, 2017, 22(1): 87-88.
6. Bista N, Shrestha KM, Bhattachan CL, et al. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities (distal 1/3 leg and foot). Nepal Med Coll J, 2013, 15(1): 56-61.
7. 柳昊, 葉澄宇, 余國榮, 等. 脛后血管蒂小腿內側復合組織瓣的臨床應用. 中國修復重建外科雜志, 2001, 15(3): 147-149.
8. 倪玉龍. 脛骨骨膜瓣的解剖學研究及臨床應用. 唐山: 華北理工大學, 2016.
9. Hou C, Chang S, Lin J, et al. Posterior tibial artery perforator flap//Surgical atlas of perforator flaps. Netherlands: Springer, 2015: 228-232.
10. 孫文晉, 陶圣祥, 余國榮, 等. 遠端蒂腓淺神經營養血管肌皮瓣的解剖與臨床應用. 中國臨床解剖學雜志, 2012, 30(2): 166-168.
11. 趙風林, 李宗寶, 王鑫, 等. 超薄型脛后動脈穿支皮瓣的解剖學觀察與臨床應用. 中華整形外科雜志, 2013, 29(4): 261-265.
12. 張天華, 魏在榮. 脛后動脈穿支皮瓣的解剖與臨床研究進展. 中國臨床解剖學雜志, 2014, 32(2): 231-233.
13. Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg, 2008, 122(1): 161-170.
14. Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg, 2005, 115(3): 793-801.
15. 柴益民, 邱勛永, 林崇正, 等. 脛后動脈穿支隱神經營養血管擬行皮瓣的臨床應用. 中華顯微外科雜志, 2004, 27(2): 99-100.
16. 陶圣祥, 喻愛喜, 鄭曉暉, 等. 隱神經營養血管復合組織瓣的解剖學研究. 中華創傷骨科雜志, 2007, 9(3): 248-250.
17. 黃凱, 郭峭峰, 林炳遠, 等. 脛后動脈穿支蒂螺旋槳皮瓣聯合植骨一期治療脛骨遠端創傷性骨髓炎. 中華顯微外科雜志, 2018, 40(1): 66-68.
18. 馮瓊華, 張遠金, 陶圣祥. 逆行隱神經營養血管肌-皮-骨復合組織瓣轉位術的臨床應用. 中國骨與關節損傷雜志, 2012, 27(9): 862-863.
19. Sahijwani H, Warikoo V, Salunke AA, et al. Anterior tibial artery perforator plus flaps: Role in coverage of posttumor excision defects around the knee joint and upper leg. Asia Pac J Oncol Nurs, 2017, 4(4): 342-347.
20. 余黎, 余國榮, 陶圣祥, 等. 小腿軟組織缺損合并節段性骨缺損的顯微外科修復. 武漢大學學報 (醫學版), 2012, 33(5): 705-707.

Chinese Journal of Reparative and Reconstructive Surgery

Application of composite tissue flaps pedicled with distal perforating branch of posterior tibial artery for repairing distal leg defects

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