Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Reconstruction of Ankle and Heel Defects with Peroneal Artery Perforator-Based Pedicled Flaps

  • Ahn, Deok Ki (Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Yonsei University College of Medicine) ;
  • Lew, Dae Hyun (Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Yonsei University College of Medicine) ;
  • Roh, Tai Suk (Department of Plastic and Reconstructive Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Won Jai (Department of Plastic and Reconstructive Surgery, Yonsei University Health System, Severance Hospital, Yonsei University College of Medicine)
  • Received : 2015.03.23
  • Accepted : 2015.06.22
  • Published : 2015.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from $5{\times}4$ to $20{\times}8cm^2$. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel.

Keywords

References

  1. Lee YH, Rah SK, Choi SJ, et al. Distally based lateral supramalleolar adipofascial flap for reconstruction of the dorsum of the foot and ankle. Plast Reconstr Surg 2004;114:1478-85.
  2. Jakubietz RG, Jakubietz DF, Gruenert JG, et al. Reconstruction of soft tissue defects of the Achilles tendon with rotation flaps, pedicled propeller flaps and free perforator flaps. Microsurgery 2010;30:608-13. https://doi.org/10.1002/micr.20798
  3. Terzic Z, Djordjevic B. Clinical aspects of reconstruction of the lower third of the leg with fasciocutaneous flap based on peroneal artery perforators. Vojnosanit Pregl 2014;71:39-45. https://doi.org/10.2298/VSP1401039T
  4. Rad AN, Singh NK, Rosson GD. Peroneal artery perforator-based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: case report and literature review. Microsurgery 2008;28:663-70. https://doi.org/10.1002/micr.20557
  5. Chang SM, Zhang K, Li HF, et al. Distally based sural fasciomyocutaneous flap: anatomic study and modified technique for complicated wounds of the lower third leg and weight bearing heel. Microsurgery 2009;29:205-13. https://doi.org/10.1002/micr.20595
  6. Hartrampf CR Jr, Scheflan M, Bostwick J 3rd. The flexor digitorum brevis muscle island pedicle flap: a new dimension in heel reconstruction. Plast Reconstr Surg 1980;66:264-70. https://doi.org/10.1097/00006534-198008000-00016
  7. Morrison WA, Crabb DM, O'Brien BM, et al. The instep of the foot as a fasciocutaneous island and as a free flap for heel defects. Plast Reconstr Surg 1983;72:56-65. https://doi.org/10.1097/00006534-198307000-00013
  8. Grabb WC, Argenta LC. The lateral calcaneal artery skin flap (the lateral calcaneal artery, lesser saphenous vein, and sural nerve skin flap). Plast Reconstr Surg 1981;68:723-30. https://doi.org/10.1097/00006534-198111000-00010
  9. Cai PH, Liu SH, Chai YM, et al. Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm. Chin Med J (Engl) 2009;122:1621-4.
  10. Koshima I, Moriguchi T, Ohta S, et al. The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg 1992;90:643-9. https://doi.org/10.1097/00006534-199210000-00014
  11. Ruan HJ, Cai PH, Schleich AR, et al. The extended peroneal artery perforator flap for lower extremity reconstruction. Ann Plast Surg 2010;64:451-7. https://doi.org/10.1097/SAP.0b013e3181b0c4f6
  12. Lu TC, Lin CH, Lin CH, et al. Versatility of the pedicled peroneal artery perforator flaps for soft-tissue coverage of the lower leg and foot defects. J Plast Reconstr Aesthet Surg 2011; 64:386-93. https://doi.org/10.1016/j.bjps.2010.05.004
  13. Ribuffo D, Atzeni M, Saba L, et al. Clinical study of peroneal artery perforators with computed tomographic angiography: implications for fibular flap harvest. Surg Radiol Anat 2010;32:329-34. https://doi.org/10.1007/s00276-009-0559-y
  14. Zhang FH, Chang SM, Lin SQ, et al. Modified distally based sural neuro-veno-fasciocutaneous flap: anatomical study and clinical applications. Microsurgery 2005;25:543-50. https://doi.org/10.1002/micr.20162
  15. Akhtar S, Hameed A. Versatility of the sural fasciocutaneous flap in the coverage of lower third leg and hind foot defects. J Plast Reconstr Aesthet Surg 2006;59:839-45. https://doi.org/10.1016/j.bjps.2005.12.009
  16. Morgan K, Brantigan CO, Field CJ, et al. Reverse sural artery flap for the reconstruction of chronic lower extremity wounds in high-risk patients. J Foot Ankle Surg 2006;45: 417-23. https://doi.org/10.1053/j.jfas.2006.09.016
  17. Lee JH, Chung DW. Reverse lateral supramalleolar adipofascial flap and skin grafting for one-stage soft tissue reconstruction of foot and ankle joint. Microsurgery 2010;30:423-9. https://doi.org/10.1002/micr.20762
  18. Masquelet AC, Romana MC. The medialis pedis flap: a new fasciocutaneous flap. Plast Reconstr Surg 1990;85:765-72. https://doi.org/10.1097/00006534-199005000-00018
  19. Park JS, Roh SG, Lee NH, et al. Versatility of the distally-based sural artery fasciocutaneous flap on the lower leg and foot in patients with chronic disease. Arch Plast Surg 2013; 40:220-5. https://doi.org/10.5999/aps.2013.40.3.220
  20. Chen YL, Zheng BG, Zhu JM, et al. Microsurgical anatomy of the lateral skin flap of the leg. Ann Plast Surg 1985;15:313-8. https://doi.org/10.1097/00000637-198510000-00007
  21. Wei FC, Chen HC, Chuang CC, et al. Fibular osteoseptocutaneous flap: anatomic study and clinical application. Plast Reconstr Surg 1986;78:191-200. https://doi.org/10.1097/00006534-198608000-00008
  22. Heitmann C, Khan FN, Levin LS. Vasculature of the peroneal artery: an anatomic study focused on the perforator vessels. J Reconstr Microsurg 2003;19:157-62. https://doi.org/10.1055/s-2003-39828
  23. Chang SM, Zhang F, Xu DC, et al. Lateral retromalleolar perforator-based flap: anatomical study and preliminary clinical report for heel coverage. Plast Reconstr Surg 2007;120: 697-704. https://doi.org/10.1097/01.prs.0000270311.00922.73
  24. Hong JP, Kim EK. Sole reconstruction using anterolateral thigh perforator free flaps. Plast Reconstr Surg 2007;119: 186-93. https://doi.org/10.1097/01.prs.0000244856.98170.9c
  25. Kuran I, Turgut G, Bas L, et al. Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area. Plast Reconstr Surg 2000;105:574-80. https://doi.org/10.1097/00006534-200002000-00015

Cited by

  1. Reverse-Flow Intrinsic Fasciocutaneous Island Flaps in Foot Reconstruction vol.16, pp.4, 2015, https://doi.org/10.1177/1534734617740253
  2. Interperforator Flow Pattern and Clinical Application of Distal Extended Peroneal Artery Perforator Flaps vol.80, pp.5, 2015, https://doi.org/10.1097/sap.0000000000001290
  3. Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot vol.21, pp.4, 2015, https://doi.org/10.1016/j.cjtee.2017.08.009
  4. Fasciocutaneous flap with perforating branches of peroneal artery repairing soft tissue loss in anterior and middle parts of children's feet : A STROBE-compliant article vol.97, pp.31, 2015, https://doi.org/10.1097/md.0000000000011351
  5. Medial Plantar Artery Perforator Flap: Experience with Soft-tissue Coverage of Heel vol.6, pp.12, 2015, https://doi.org/10.1097/gox.0000000000001991
  6. Double-pedicle propeller flap for reconstruction of the foot and ankle: anatomical study and clinical applications vol.47, pp.10, 2015, https://doi.org/10.1177/0300060519865625
  7. Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue vol.28, pp.3, 2015, https://doi.org/10.1177/2309499020971863
  8. Heel Reconstruction With Bipedicled Flap: A Salvage Procedure vol.19, pp.4, 2015, https://doi.org/10.1177/1534734620905738