Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Wanqiu , XU Yongqing ,  HE Xiaoqing , LUO Haotian , XU Yujian

Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650032, P.R.China;

Corresponding?author：

HE Xiaoqing, Email: hxq00@foxmail.com

Keywords：

Propeller flap; peroneal artery perforator; digital technology; heel; wound repair

DOI：

10.7507/1002-1892.201908079

Video：

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Objective To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.Methods Between March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained.Results The origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements (P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.Conclusion The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.

Citation： ZHAO Wanqiu, XU Yongqing, HE Xiaoqing, LUO Haotian, XU Yujian. Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 367-372. doi: 10.7507/1002-1892.201908079 Copy

1.	?zalp B, Ayd?nol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
2.	Mendieta M, Cabrera R, Siu A, et al. Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects. Plast Reconstr Surg Glob Open, 2018, 6(5): e1759.
3.	Yu D, Hou Q, Liu A, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique. Surg Radiol Anat, 2016, 38(9): 1075-1081.
4.	張元智, 陸聲, 溫樹正, 等. 數字化技術在隱動脈皮瓣血供的可視化及其臨床初步應用. 中華創傷骨科雜志, 2013, 15(1): 32-35.
5.	Laungani AT, Van Alphen N, Christner JA, et al. Three-dimensional CT angiography assessment of the impact of the dermis and the subdermal plexus in DIEP flap perfusion. J Plast Reconstr Aesthet Surg, 2015, 68(4): 525-530.
6.	卿黎明, 胡懿郃, 唐舉玉, 等. 基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究. 中國修復重建外科雜志, 2014, 28(6): 697-700.
7.	Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. J Plast Reconstr Surg, 2008, 122(2): 429-437.
8.	李國棟, 徐永清, 何曉清, 等. 數字化技術在外側腓腸淺動脈穿支皮瓣修復手部中小創面中的應用研究. 中國修復重建外科雜志, 2017, 31(5): 564-569.
9.	王順吉, 章文博, 于堯, 等. 術前虛擬設計在股前外側皮瓣修復口腔頜面部缺損中的應用. 北京大學學報 (醫學版), 2019, 17(12): 1242-1247.
10.	唐舉玉, 卿黎明, 賀繼強, 等. 數字化技術輔助旋股外側動脈降支分葉穿支皮瓣設計的初步應用. 中華顯微外科雜志, 2016, 13(2): 123-126.
11.	莫勇軍, 譚海濤, 楊克勤, 等. 數字化技術輔助股前外側皮瓣移植修復四肢軟組織缺損 24 例. 中華顯微外科雜志, 2015, 38(6): 592-595.
12.	段家章, 何曉清, 徐永清, 等. 數字化技術在股前外側皮瓣修復手足創面中的應用. 中國修復重建外科雜志, 2015, 9(7): 807-811.
13.	Hupkens P, Schijns W, Van Abeelen M, et al. Lateral lower leg perforator flaps: an anatomical study to localize and classify lateral lower leg perforators. Microsurgery, 2015, (35): 140-147.
14.	Sur YJ, Morsy M, Mohan AT, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg, 2016, 137(5): 1615-1628.
15.	Punyavong P, Winaikosol K, Jenwitheesuk K, et al. An anatomical study of vascular supply of the distally based sural artery flap: a cadaveric study. J Med Assoc Thai, 2016, 99 Suppl 5: S182-S186.
16.	Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
17.	周洪翔, 陳亮, 李俊杰, 等. 改良螺旋槳穿支皮瓣在修復足跟周圍軟組織缺損中的應用. 中國矯形外科雜志, 2017, 25(6): 517-520.
18.	Acartürk TO, Maldonado AA, Ereso A. Intraoral reconstruction with “thinned” peroneal artery perforator flaps: An alternative to classic donor areas in comorbid patients. Microsurgery, 2015, 35(5): 399-402.
19.	Dhua S, Manashree S, Tilak BG, et al. The clinical outcome of perforator based sural artery and propeller flaps in reconstruction of soft tissue of extremities. World J Plast Surg, 2019, 8(1): 3-11.
20.	Ono S, Hayashi H, Ohi H, et al. Imaging studies for preoperative planning of perforator flaps: an overview. Clin Plast Surg, 2017, 44(1): 21-30.
21.	陶友倫, 張世民, 陳文龍, 等. 穿支血管蒂螺旋槳皮瓣蒂部血管扭轉的非線性有限元模擬研究. 中國臨床解剖學雜志, 2014, 32(2): 201-205.
22.	張子陽, 張文奪, 魏再榮, 等. 數字減影血管造影在脛后動脈穿支皮瓣修復足踝部創面中的應用研究. 中國修復重建外科雜志, 2015, 29(9): 1109-1112.

1. ?zalp B, Ayd?nol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg, 2016, 69(10): e205-e211.
2. Mendieta M, Cabrera R, Siu A, et al. Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects. Plast Reconstr Surg Glob Open, 2018, 6(5): e1759.
3. Yu D, Hou Q, Liu A, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique. Surg Radiol Anat, 2016, 38(9): 1075-1081.
4. 張元智, 陸聲, 溫樹正, 等. 數字化技術在隱動脈皮瓣血供的可視化及其臨床初步應用. 中華創傷骨科雜志, 2013, 15(1): 32-35.
5. Laungani AT, Van Alphen N, Christner JA, et al. Three-dimensional CT angiography assessment of the impact of the dermis and the subdermal plexus in DIEP flap perfusion. J Plast Reconstr Aesthet Surg, 2015, 68(4): 525-530.
6. 卿黎明, 胡懿郃, 唐舉玉, 等. 基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究. 中國修復重建外科雜志, 2014, 28(6): 697-700.
7. Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. J Plast Reconstr Surg, 2008, 122(2): 429-437.
8. 李國棟, 徐永清, 何曉清, 等. 數字化技術在外側腓腸淺動脈穿支皮瓣修復手部中小創面中的應用研究. 中國修復重建外科雜志, 2017, 31(5): 564-569.
9. 王順吉, 章文博, 于堯, 等. 術前虛擬設計在股前外側皮瓣修復口腔頜面部缺損中的應用. 北京大學學報 (醫學版), 2019, 17(12): 1242-1247.
10. 唐舉玉, 卿黎明, 賀繼強, 等. 數字化技術輔助旋股外側動脈降支分葉穿支皮瓣設計的初步應用. 中華顯微外科雜志, 2016, 13(2): 123-126.
11. 莫勇軍, 譚海濤, 楊克勤, 等. 數字化技術輔助股前外側皮瓣移植修復四肢軟組織缺損 24 例. 中華顯微外科雜志, 2015, 38(6): 592-595.
12. 段家章, 何曉清, 徐永清, 等. 數字化技術在股前外側皮瓣修復手足創面中的應用. 中國修復重建外科雜志, 2015, 9(7): 807-811.
13. Hupkens P, Schijns W, Van Abeelen M, et al. Lateral lower leg perforator flaps: an anatomical study to localize and classify lateral lower leg perforators. Microsurgery, 2015, (35): 140-147.
14. Sur YJ, Morsy M, Mohan AT, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg, 2016, 137(5): 1615-1628.
15. Punyavong P, Winaikosol K, Jenwitheesuk K, et al. An anatomical study of vascular supply of the distally based sural artery flap: a cadaveric study. J Med Assoc Thai, 2016, 99 Suppl 5: S182-S186.
16. Shen L, Liu Y, Zhang C, et al. Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion. J Int Med Res, 2017, 45(3): 1074-1089.
17. 周洪翔, 陳亮, 李俊杰, 等. 改良螺旋槳穿支皮瓣在修復足跟周圍軟組織缺損中的應用. 中國矯形外科雜志, 2017, 25(6): 517-520.
18. Acartürk TO, Maldonado AA, Ereso A. Intraoral reconstruction with “thinned” peroneal artery perforator flaps: An alternative to classic donor areas in comorbid patients. Microsurgery, 2015, 35(5): 399-402.
19. Dhua S, Manashree S, Tilak BG, et al. The clinical outcome of perforator based sural artery and propeller flaps in reconstruction of soft tissue of extremities. World J Plast Surg, 2019, 8(1): 3-11.
20. Ono S, Hayashi H, Ohi H, et al. Imaging studies for preoperative planning of perforator flaps: an overview. Clin Plast Surg, 2017, 44(1): 21-30.
21. 陶友倫, 張世民, 陳文龍, 等. 穿支血管蒂螺旋槳皮瓣蒂部血管扭轉的非線性有限元模擬研究. 中國臨床解剖學雜志, 2014, 32(2): 201-205.
22. 張子陽, 張文奪, 魏再榮, 等. 數字減影血管造影在脛后動脈穿支皮瓣修復足踝部創面中的應用研究. 中國修復重建外科雜志, 2015, 29(9): 1109-1112.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of digital technology in repairing of heel wound with peroneal artery perforator propeller flap

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