APPLICATION OF FREE BILOBED MEDIAL SURAL ARTERY PERFORATOR FLAP FOR REPAIRING PENETRATING WOUND OF FOOT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHENGDawei ¹ , LIZhangcan ¹ , CAOGuangchao ¹ , WUYao ¹ , SHIRongjian ¹ , SUNFeng ¹ , SHOUKuishui ²

1. Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221004, P. R. China;
2. Department of Hand Surgery, Wuxi Hand Surgery Hospital;

Corresponding?author：

ZHENGDawei, Email: davyzheng93006@163.com

Keywords：

Medial sural artery perforator flap; Bilobed flap; Foot; Penetrating injury; Wound repair

DOI：

10.7507/1002-1892.20150325

Video：

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Objective To explore the effectiveness of the free bilobed medial sural artery perforator (BMSAP) flap to repair penetrating wound of the foot. Methods Between April 2012 and October 2014, 7 cases of foot penetrating wounds were treated with the BMSAP flap. There were 5 males and 2 females, aged from 21 to 43 years (mean, 31.5 years). The causes of injury included the crush injury (4 cases), blunt puncture (2 cases), and firearm injury (1 case). The wound was located at the left foot in 4 cases and at the right foot in 3 cases. There were longitudinal penetrating injury in 5 cases and transverse penetrating injury in 2 cases. The size of wound ranged from 4 cm×3 cm to 9 cm×7 cm. The interval between injury and admission was 0.5-5.5 hours (mean, 3.2 hours). The free BMSAP flap of 5 cm×4 cm-10 cm×8 cm in size was used to repair the wounds on both sides and to reconstruct the sensation. The donor site was sutured or repaired with skin graft. Results After operation, 1 case had distal flap necrosis, the flap survived after dressing change; 1 case had wound infection, and delayed healing was obtained after drainage; and the flap survived completely, and primary healing was obtained in the other 5 cases. The skin grafts survived and healing of incision by first intention was observed at donor sites. The patients were followed up from 7 to 24 months (mean, 12.5 months). The flap had soft texture and similar color to normal skin. According to the British Medical Research Council (BMRC) sensory function assessment system, 1 case was rated as S₂, 4 cases as S₃, and 2 cases as S₃₊. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 86-97 (mean, 93.6); the results were excellent in 6 cases and good in 1 case. Conclusion The free BMSAP flap is very suitable to repair penetrating wound of the foot. The flap has the advantages of repairing the two wounds at the same time and reconstructing skin sensation as well.

Citation： ZHENGDawei, LIZhangcan, CAOGuangchao, WUYao, SHIRongjian, SUNFeng, SHOUKuishui. APPLICATION OF FREE BILOBED MEDIAL SURAL ARTERY PERFORATOR FLAP FOR REPAIRING PENETRATING WOUND OF FOOT. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(12): 1519-1522. doi: 10.7507/1002-1892.20150325 Copy

1.	蘇日寶, 安洪賓, 王秀會, 等. 第一跖背動脈皮瓣串聯趾腓側皮瓣移植修復手部貫通傷. 中國修復重建外科雜志, 2014, 28(12):1567-1568.
2.	肖鵬康, 豐德寬, 王濤, 等. 啞鈴狀雙葉皮瓣修復合并組織缺損的手部貫通傷. 中國修復重建外科雜志, 1997, 11(4):226-228.
3.	Ju J, Hou R. Reconstruction of penetrating injuries of the hand with dorsalis pedis composite free flaps:a series of 23 patients. J Plast Reconstr Aest Surg, 2012, 65(10):1368-1376.
4.	Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
5.	劉娟, 鄭懷遠, 陳江海, 等. 應用游離腓腸內側動脈穿支皮瓣修復足部小面積潰瘍. 中華顯微外科雜志, 2013, 36(6):573-575.
6.	Zheng H, Liu J, Dai X, et al. Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J Plast Reconstr Aest Surg, 2015, 68(4):565-570.
7.	唐茂林, 徐永清, 張世民. 穿支皮瓣的應用解剖與臨床. 北京:科學出版社, 2013:103-104, 244-248.
8.	Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap:an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5):1609-1618.
9.	Susan E, Mackinnon A, Lee Dellon. 周圍神經外科學. 朱家愷, 盧傳新, 王書成, 等譯. 海口:三環出版社, 1991:35-38.
10.	劉鳴江, 唐舉玉, 吳攀峰, 等. 逆行腓腸神經營養血管皮瓣的感覺重建. 中華顯微外科雜志, 2011, 34(3):194-197.
11.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
12.	鄒林, 蔡錦方, 劉立峰, 等. 小腿外側腓骨皮瓣交腿修復合并血管損傷的大段脛骨骨感染及缺損. 中華骨科雜志, 2012, 32(7):675-680.
13.	黃東, 歐陽海洋, 吳偉熾, 等. 足部皮膚軟組織缺損皮瓣修復的選擇. 中華顯微外科雜志, 2013, 36(6):577-579.
14.	曹廣超, 鄭大偉, 孫峰, 等. 預構感覺皮瓣修復足跟軟組織撕脫傷. 中國修復重建外科雜志, 2015, 29(2):198-201.
15.	李軍, 范新宇, 朱躍良, 等. 幾種方法修復前足軟組織缺損的療效分析. 中華創傷雜志, 2014, 30(11):1100-1102.
16.	趙國紅, 謝振軍, 孫華偉, 等. 腓腸內側動脈穿支皮瓣修復小腿中上段軟組織缺損. 中華顯微外科雜志, 2013, 36(4):372-374.
17.	Wang X, Mei J, Pan J, et al. Reconstruction of distal limb defects with the free medial sural artery perforator flap. Plast Reconstr Surg, 2013, 131(1):95-105.
18.	Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap:a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9):1267-1275.
19.	張功林, 陳克明, 龔鐵軍, 等. 腓腸內側動脈為蒂雙葉肌皮瓣移植術. 國際骨科學雜志, 2012, 33(2):137-138.
20.	Chang H, Minn KW, Imanishi N, et al. Effect of venous superdrainage on a four-territory skin flap survival in rats. Plast Reconstr Surg, 2007, 119(7):2046-2051.
21.	徐永清, 范新宇. 穿支皮瓣臨床應用的若干問題探討. 中華創傷雜志, 2014, 30(11):1082-1084.
22.	劉傳波, 黃瑤, 葉俊娜, 等. 糖尿病足潰瘍預后相關因素研究. 中華創傷雜志, 2014, 30(4):291-297.
23.	潘佳棟, 王欣, 梅勁, 等. 游離腓腸內側動脈穿支皮瓣修復手足皮膚軟組織缺損. 中華顯微外科雜志, 2012, 35(2):93-95.

1. 蘇日寶, 安洪賓, 王秀會, 等. 第一跖背動脈皮瓣串聯趾腓側皮瓣移植修復手部貫通傷. 中國修復重建外科雜志, 2014, 28(12):1567-1568.
2. 肖鵬康, 豐德寬, 王濤, 等. 啞鈴狀雙葉皮瓣修復合并組織缺損的手部貫通傷. 中國修復重建外科雜志, 1997, 11(4):226-228.
3. Ju J, Hou R. Reconstruction of penetrating injuries of the hand with dorsalis pedis composite free flaps:a series of 23 patients. J Plast Reconstr Aest Surg, 2012, 65(10):1368-1376.
4. Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
5. 劉娟, 鄭懷遠, 陳江海, 等. 應用游離腓腸內側動脈穿支皮瓣修復足部小面積潰瘍. 中華顯微外科雜志, 2013, 36(6):573-575.
6. Zheng H, Liu J, Dai X, et al. Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J Plast Reconstr Aest Surg, 2015, 68(4):565-570.
7. 唐茂林, 徐永清, 張世民. 穿支皮瓣的應用解剖與臨床. 北京:科學出版社, 2013:103-104, 244-248.
8. Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap:an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5):1609-1618.
9. Susan E, Mackinnon A, Lee Dellon. 周圍神經外科學. 朱家愷, 盧傳新, 王書成, 等譯. 海口:三環出版社, 1991:35-38.
10. 劉鳴江, 唐舉玉, 吳攀峰, 等. 逆行腓腸神經營養血管皮瓣的感覺重建. 中華顯微外科雜志, 2011, 34(3):194-197.
11. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
12. 鄒林, 蔡錦方, 劉立峰, 等. 小腿外側腓骨皮瓣交腿修復合并血管損傷的大段脛骨骨感染及缺損. 中華骨科雜志, 2012, 32(7):675-680.
13. 黃東, 歐陽海洋, 吳偉熾, 等. 足部皮膚軟組織缺損皮瓣修復的選擇. 中華顯微外科雜志, 2013, 36(6):577-579.
14. 曹廣超, 鄭大偉, 孫峰, 等. 預構感覺皮瓣修復足跟軟組織撕脫傷. 中國修復重建外科雜志, 2015, 29(2):198-201.
15. 李軍, 范新宇, 朱躍良, 等. 幾種方法修復前足軟組織缺損的療效分析. 中華創傷雜志, 2014, 30(11):1100-1102.
16. 趙國紅, 謝振軍, 孫華偉, 等. 腓腸內側動脈穿支皮瓣修復小腿中上段軟組織缺損. 中華顯微外科雜志, 2013, 36(4):372-374.
17. Wang X, Mei J, Pan J, et al. Reconstruction of distal limb defects with the free medial sural artery perforator flap. Plast Reconstr Surg, 2013, 131(1):95-105.
18. Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap:a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9):1267-1275.
19. 張功林, 陳克明, 龔鐵軍, 等. 腓腸內側動脈為蒂雙葉肌皮瓣移植術. 國際骨科學雜志, 2012, 33(2):137-138.
20. Chang H, Minn KW, Imanishi N, et al. Effect of venous superdrainage on a four-territory skin flap survival in rats. Plast Reconstr Surg, 2007, 119(7):2046-2051.
21. 徐永清, 范新宇. 穿支皮瓣臨床應用的若干問題探討. 中華創傷雜志, 2014, 30(11):1082-1084.
22. 劉傳波, 黃瑤, 葉俊娜, 等. 糖尿病足潰瘍預后相關因素研究. 中華創傷雜志, 2014, 30(4):291-297.
23. 潘佳棟, 王欣, 梅勁, 等. 游離腓腸內側動脈穿支皮瓣修復手足皮膚軟組織缺損. 中華顯微外科雜志, 2012, 35(2):93-95.

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APPLICATION OF FREE BILOBED MEDIAL SURAL ARTERY PERFORATOR FLAP FOR REPAIRING PENETRATING WOUND OF FOOT

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