Archives of Hand and Microsurgery

The Korean Society for Surgery of the Hand (대한수부외과학회)
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Survival of Neuro-Venous Flap without Perforator due to Accidental Division of Perforator

돌발적 손상에 의해 천공지가 없는 신경-정맥피판의 생존

  • Byeon, Je Yeon (Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine) ;
  • Choi, Hwan Jun (Department of Plastic and Reconstructive Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine)
  • 변제연 (순천향대학교 의과대학 천안병원 성형외과학교실) ;
  • 최환준 (순천향대학교 의과대학 천안병원 성형외과학교실)
  • Received : 2018.07.25
  • Accepted : 2018.10.08
  • Published : 2018.12.01
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Abstract

Author planed peroneal artery perforator flap for ankle reconstruction and experienced successful result using sural neuro-lesser saphenous venous flap due to an unexpected event. A male Asian patient, 24 years old, had a history of recurrent operation wound disruption in the ankle region. Under general anesthesia, peroneal perforator and saphenous vein, as well as the sural nerve branches, were identified and preserved. In the process of flap rotation, an accidental division of peroneal artery perforator has occurred. Despite the division of the perforator, circulation was normal. The patient experienced no complication after the surgery. Some study reported that accompanying arteries and the vascular plexus around the sural nerve communicate. In conclusion, sufficient blood supply was possible only with the accompanying artery of the sural nerve without peroneal perforator. So, it is essential to always preserve not only perforator but also neurovascular bundles at any circumstances and any location.

저자는 종아리동맥의 천공지를 이용하여 발목을 재건하려는 중 천공지가 절단되어 비복신경과 복재정맥만 보존된 피판의 성공적인 생존을 경험하였다. 24세 아시안 남성에서 전신마취 하에 종아리 동맥 천공지, 복재정맥, 비복신경을 확인하고 보존하고 피판을 회전시키는 과정에서 종아리 동맥 천공지의 절단이 발생하였다. 천공지의 손상에도 불구하고 피판의 경계에서 혈행이 확인되었다. 수술 후 환자는 특이 합병증 없이 회복되었고, 미용적인 결과와 기능적인 결과에서 모두 만족스러웠다. 몇몇 연구에서 비복신경과 동반하는 혈행을 보고하고 있다. 결과적으로, 종아리 동맥의 천공지 없이 비복신경과 동반하는 동맥의 혈류만으로도 충분한 혈액 공급이 가능하였다. 따라서 어느 환경에서나 그리고 어느 부위에서나 피판의 천공지뿐만 아니라 신경-혈관을 보존하는 것이 중요하다.

Keywords

Acknowledgement

Supported by : Soonchunhyang University

References

  1. Guiraldo RPA, Cabral CM, Nora RT, Gasques JAL, Bozola AR. Severe lower limb trauma. Rev Bras Cir Plast. 2013;28:320-3. https://doi.org/10.1590/S1983-51752013000200027
  2. Khurram MF, Ahmad I, Nanda M. Soft tissue reconstruction of foot and ankle defects: free vs pedicled flaps with the use of 6 different flaps in 50 cases of road traffic accidents. Austin J Surg. 2014;1:1031.
  3. Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg. 1981;34:215-20. https://doi.org/10.1016/S0007-1226(81)80097-5
  4. Harrison DH, Morgan BD. The instep island flap to resurface plantar defects. Br J Plast Surg. 1981;34:315-8. https://doi.org/10.1016/0007-1226(81)90019-9
  5. Masquelet AC, Romanan MC, Wolf G. Skin island flap supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg. 1992;89:1115-21. https://doi.org/10.1097/00006534-199206000-00018
  6. Yilmaz M, Karatas O, Barutcu A. The distally based superficial sural artery island flap: clinical experiences and modifications. Plast Reconstr Surg. 1998;102:2358-67. https://doi.org/10.1097/00006534-199812000-00013
  7. Serafin D, Georgiade NG, Smith DH. Comparison of free flap with pedicled flaps for coverage of defects of the leg or foot. Plast Reconstr Surg. 1977;59:492-9. https://doi.org/10.1097/00006534-197759040-00003
  8. Sladjana UZ, Ivan JD, Ljiljana VP, Natalija SJ, Predrag KT, Vesna SR. Neurovascular stalk of the superficial sural flap: human fetus anatomical study. Plast Reconstr Surg. 2005;116:546-50. https://doi.org/10.1097/01.prs.0000172891.51483.01
  9. Oberlin C, Azoulay B, Bhatia A. The posterolateral malleolar flap of the ankle: a distally based sural neurocutaneous flap--report of 14 cases. Plast Reconstr Surg. 1995;96:400-5; discussion 406-7. https://doi.org/10.1097/00006534-199508000-00021
  10. Lee HI, Ha SH, Yu SO, Park MJ, Chae SH, Lee GJ. Reverse sural artery island flap with skin extension along the pedicle. J Foot Ankle Surg. 2016;55:470-5. https://doi.org/10.1053/j.jfas.2015.07.014