Distally Based Extended Peroneal Artery Septocutaneous Perforator Cross-Bridge Flap without Microvascular Anastomoses for Reconstruction of Contralateral Leg and Foot Soft Tissue Defects

Abstract Background Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, reports on the reconstruction of the defects over the distal forefoot using the DPAPF flaps are scarce. Herein, we describe our experience on the reconstruction of these defects using DPAPF flaps in a considerable sample size. Methods Between February 2005 and August 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. In order to reduce the length of fascial pedicle and the total length of the DPAPF flaps, the ankles were fixed in dorsiflexion using a Kirschner wire before designing the flaps. The flaps were elevated by the anterograde–retrograde approach. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups. Results Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 ± 0.58 cm, the total length of the flap was simultaneously shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from 3.0 cm to 6.0 cm. The fascial pedicle width > 4 cm was found in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05). Conclusions The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. By fixing the ankle in dorsiflexion with Kirschner wire and widening the fascial pedicle appropriately, the top edge and LWR of the flaps will be decreased, and thus the procedures are helpful for the flaps survival.

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Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

10.21203/rs.3.rs-43530/v1 ◽

2020 ◽

Author(s):

Ping Peng ◽

Zhaobiao Luo ◽

Guohua Lv ◽

Jiangdong Ni ◽

Jianwei Wei ◽

...

Keyword(s):

Soft Tissue ◽

Kirschner Wire ◽

Fasciocutaneous Flap ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Patient Factors ◽

Partial Necrosis ◽

Distally Based ◽

Artery Perforator ◽

Tissue Defects

Abstract Background: Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, large studies on this topic, especially DPAPF flaps use for reconstruction of defects over the distal forefoot, are scarce. Herein, we describe our experience on the reconstruction of defects over the distal forefoot using DPAPF flaps.Methods: Between February 2005 and August 2019, 56 DPAPF flaps were used to reconstruct soft-tissue defects in the forefoot. The ankles were fixed in dorsiflexion using a Kirschner wire. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups.Results: Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. The distance between the pivot point and recipient area was reduced by fixing the ankles in dorsiflexion. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05).Conclusions: In combination with fixing of the ankles in dorsiflexion using a Kirschner wire, DPAPF flap is a good option in reconstructing a defect over the distal forefoot.

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Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

10.21203/rs.3.rs-43530/v2 ◽

2020 ◽

Author(s):

Ping Peng ◽

Zhaobiao Luo ◽

Guohua Lv ◽

Jiangdong Ni ◽

Jianwei Wei ◽

...

Keyword(s):

Soft Tissue ◽

Kirschner Wire ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Partial Necrosis ◽

Total Length ◽

Distally Based ◽

Artery Perforator ◽

Pedicle Width ◽

Tissue Defects

Abstract Background Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, reports on the reconstruction of the defects over the distal forefoot using the DPAPF flaps are scarce. Herein, we describe our experience on the reconstruction of these defects using DPAPF flaps in a considerable sample size. Methods Between February 2005 and August 2019, a total of 56 DPAPF flaps in 56 patients were used to reconstruct soft-tissue defects in the forefoot. In order to reduce the length of fascial pedicle and the total length of the DPAPF flaps, the ankles were fixed in dorsiflexion using a Kirschner wire before designing the flaps. The flaps were elevated by the anterograde–retrograde approach. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups. Results Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. By fixing the ankles in dorsiflexion, the length of the fascial pedicle was reduced approximately 2.35 ± 0.58 cm, the total length of the flap was simultaneously shortened by the same amount as the length of the fascial pedicle. The width of the fascia pedicle varied from 3.0 cm to 6.0 cm. The fascial pedicle width > 4 cm was found in 21 flaps. The partial necrosis rate of the DPAPF flaps with the top-edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05).Conclusions The DPAPF flaps can be effectively used to reconstruct the defects over the distal forefoot because of convenient harvest and reliability. By fixing ankle in dorsiflexion with Kirschner wire and widening the fascial pedicle appropriately, the top-edge and LWR of the flaps will be decreased, and thus the procedures are helpful for the flaps survival.

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Distally Based Peroneal Artery Perforator-Plus Fasciocutaneous Flap to Reconstruct Soft Tissue Defect Combined With Chronic Osteomyelitis in the Lateral Malleolus

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620956782 ◽

2020 ◽

pp. 153473462095678

Author(s):

Zhaobiao Luo ◽

Zhonggen Dong ◽

Jiangdong Ni ◽

Jianwei Wei ◽

Ping Peng ◽

...

Keyword(s):

Soft Tissue ◽

Chronic Osteomyelitis ◽

Soft Tissue Defect ◽

Lateral Malleolus ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Distally Based ◽

Artery Perforator ◽

Tissue Defects

Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used to reconstruct soft tissue defects of the lower extremity. Treatment for soft tissue defect combined with chronic osteomyelitis in the lateral malleolus has rarely been reported. The aim of this study was to elaborate the superiority of the DPAPF flap and provide referential experience for using the DPAPF flap in this situation. Between June 2010 and December 2017, soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus were reconstructed with DPAPF flaps in 17 patients. After thorough debridement, the defect was repaired with the DPAPF flap, and patients subsequently followed an antibiotic regimen for 6 weeks. Follow-up periods for all patients were at least 24 months. The reconstruction outcomes and the satisfaction of the 17 patients were evaluated. Of the 17 flaps, 16 survived uneventfully, except one occurrence of partial necrosis. No infection occurred in the follow-up period. In the study, 17 patients except one were satisfied with flap appearance. All the patients were satisfied with the reconstruction outcomes. In a one-stage procedure, the use of DPAPF flaps is ideal for reconstructing soft tissue defects in the setting of chronic osteomyelitis in the lateral malleolus.

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Reconstruction of soft tissue defects around the Achilles region with distally based extended peroneal artery perforator flap

Injury ◽

10.1016/j.injury.2021.04.015 ◽

2021 ◽

Author(s):

Altug Altinkaya ◽

Sukru Yazar ◽

Fuat Baris Bengur

Keyword(s):

Soft Tissue ◽

Perforator Flap ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Distally Based ◽

Artery Perforator ◽

Tissue Defects

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Reconstruction of soft tissue defects of the lower leg with the distally based medial adipofascial flap

British Journal of Plastic Surgery ◽

10.1016/0007-1226(94)90173-2 ◽

1994 ◽

Vol 47 (2) ◽

pp. 132-137 ◽

Cited By ~ 29

Author(s):

Sin-Daw Lin ◽

Chung-Sheng Lai ◽

Chih-Kang Chou ◽

Chin-Wei Tsai ◽

Chin-Cheng Tsai

Keyword(s):

Soft Tissue ◽

Lower Leg ◽

Soft Tissue Defects ◽

Adipofascial Flap ◽

Distally Based ◽

Tissue Defects

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Restoration of middle third leg soft tissue defects using a distally based hemigastrocnemius flap

Al-Azhar Assiut Medical Journal ◽

10.4103/azmj.azmj_139_19 ◽

2021 ◽

Vol 19 (2) ◽

pp. 319

Author(s):

WaelMohamed Ayad ◽

Alhosiney Salalheldin Elhosiney ◽

AhmedAbu ElsoudSalim

Keyword(s):

Soft Tissue ◽

Soft Tissue Defects ◽

Distally Based ◽

Tissue Defects

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Peroneal perforator pedicle propeller flap for lower leg soft tissue defect reconstruction: Clinical applications and treatment of venous congestion

Journal of International Medical Research ◽

10.1177/0300060516687229 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1074-1089 ◽

Cited By ~ 10

Author(s):

Lifeng Shen ◽

Yiyang Liu ◽

Chun Zhang ◽

Qiaofeng Guo ◽

Wenhua Huang ◽

...

Keyword(s):

Soft Tissue ◽

Donor Site ◽

Lower Leg ◽

Soft Tissue Defect ◽

Venous Congestion ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Propeller Flap ◽

Perforator Vessel ◽

Tissue Defects

Objective To describe the characteristics of the perforator vessel in the peroneal artery of the lower leg and to explore the use of perforator pedicle propeller flaps to repair soft tissue defects in the lower leg, heel and foot. Methods This retrospective study enrolled patients with soft tissue defects of the distal lower leg, heel and foot who underwent surgery using peroneal perforator-based propeller flaps. The peroneal artery perforators were identified preoperatively by colour duplex Doppler ultrasound. The flap was designed based on the preoperatively-identified perforator location, with the posterior border of the fibula employed as an axis, and the perforator vessel as the pivot point of rotation. Patients were followed-up to determine the outcomes. Results The study analysed 36 patients (mean age, 39.7 years). The majority of the soft tissue defects were on the heel (20; 55.6%). The donor-site of the flap was closed in 11 patients by direct suturing and skin grafting was undertaken in 25 patients. Postoperative complications included venous congestion (nine patients), which was managed with delayed wound coverage and bleeding therapy. All wounds were eventually cured and the flaps were cosmetically acceptable. Conclusions The peroneal perforator pedicle propeller flap is an appropriate choice to repair soft tissue defects of the distal limbs.

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