Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Tao ¹ ,  ZHANG Yuxuan ² , XU Yajun ² , ZHOU Jiandong ² , XU Tonglong ² , ZHANG Xingfei ² , HU Yuxuan ²

1. Department of Hand Surgery, Yixing People’s Hospital, Yixing Jiangsu, 214200, P. R. China;
2. Department of Foot and Ankle Surgery, Wuxi No.9 People’s Hospital, Wuxi Jiangsu, 214000, P. R. China;

Corresponding?author：

ZHANG Yuxuan, Email: hao0821@126.com

Keywords：

Medial sural artery perforator flap; wide band linear matrix array volume transducer probe; three-dimensinal ultrasound technique; dorsum of foot; wound repair

DOI：

10.7507/1002-1892.202312079

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Objective To investigate the accuracy of positioning perforator of medial sural artery with three-dimensional ultrasound technique guided by a wide band linear matrix array volume transducer probe before operation, and the effectiveness of the flap design based on this in repairing the dorsal foot wounds. Methods Between January 2019 and December 2022, 30 patients with skin and soft tissue defects of the dorsal foot were treated. There were 19 males and 11 females, with an average age of 43.9 years (range, 22-63 years). There were 12 cases of traffic accident injury, 15 cases of heavy crushing injury, and 3 cases of machine injury. The time from injury to hospitalization was 1-8 hours (mean, 3.5 hours). The wounds in size of 5 cm×3 cm to 17 cm×5 cm were thorough debrided and covered with vacuum sealing drainage dressing. Then the wounds were repaired with the medial sural artery perforator flaps after no obvious infection observed. To obtain the complete three-dimensional image, the number and position of the medial sural artery perforator branches and the position of the main blood vessels in the muscle were detected and recorded by wide band linear matrix array volume transducer probe before operation. Suitable perforating branches were selected to design the flap and guide the flap incision on this basis. The size of the perforating flap ranged from 6 cm×4 cm to 18 cm×6 cm. The sensitivity and positive predictive value were calculated by comparing preoperative exploration with intraoperative observation of perforating branches, so as to evaluate the positioning accuracy of three-dimensional ultrasound technique. The donor sites were sutured directly in 25 cases and repaired with free skin grafting in 5 cases. Results The 60 perforating branches of medial sural artery were found before operation and 58 during operation in 30 patients. Among them, pre- and intra-operative perforations were consistent with 56. The sensitivity was 93.3% and positive predictive value was 96.6%. The intramuscular position and route of the main blood vessels were basically consistent with the pre- and intra-operative observation. All flaps survived and wounds healed by first intention. All incisions at the donor sites healed by first intention, and all skin grafts survived. All patients were follow up 9-24 months (mean, 14.7 months). The appearance, color, and texture of the flaps were good, and no obvious effect on wearing shoes and walking. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind score ranged from 80 to 92, with an average of 87.5. The patient satisfaction was excellent in 29 cases and good in 1 case. Conclusion The three-dimensional ultrasound technique guided by the wide band linear matrix array volume transducer probe can accurately locate the perforating branch of the medial sural artery, and the three-dimensional imaging is more intuitive, which can be used to guide the design and incision of the medial sural artery perforator flap.

Citation： MA Tao, ZHANG Yuxuan, XU Yajun, ZHOU Jiandong, XU Tonglong, ZHANG Xingfei, HU Yuxuan. Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 593-597. doi: 10.7507/1002-1892.202312079 Copy

1.	冉小葉, 劉元波, 楊若夢, 等. 穿支螺旋槳皮瓣連續轉移技術在下肢遠端軟組織缺損修復中的臨床應用. 中國修復重建外科雜志, 2022, 36(4): 451-455.
2.	彭平, 董忠根, 魏建偉, 等. 逆行帶蒂腓腸筋膜皮瓣的部分壞死相關因素分析. 中國矯形外科雜志, 2022, 30(8): 673-677.
3.	陳玉兵, 王麗麗. 足背動脈穿支蒂皮瓣修復前足背側皮膚軟組織缺損療效觀察. 中國修復重建外科雜志, 2017, 31(5): 632-634.
4.	Mehmood Hashmi P, Musaddiq A, Hashmi A, et al. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Ann Med Surg (Lond), 2021, 73: 103109. doi: 10.1016/j.amsu.2021.103109.
5.	舒景坤, 李紅, 趙連偉. 旋轉點下移的外踝上皮瓣修復足內側皮膚軟組織缺損. 實用手外科雜志, 2021, 35(4): 497-499.
6.	范愛民, 陳燕, 李政, 等. 游離股前外側穿支皮瓣修復足踝部軟組織缺損. 中國矯形外科雜志, 2022, 30(10): 937-939.
7.	徐寶成, 蒙顯晨, 汪金根, 等. 游離腓腸內側動脈穿支皮瓣修復四肢軟組織缺損. 中華手外科雜志, 2022, 38(3): 233-235.
8.	方杰, 陳步國, 吳堯, 等. 腓腸內側動脈穿支皮瓣臨床應用研究進展. 中國修復重建外科雜志, 2021, 35(4): 508-513.
9.	Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
10.	楊濤, 趙磊, 宋科, 等. 游離腓腸內側動脈穿支皮瓣對足趾皮膚缺損的美學修復. 中華整形外科雜志, 2022, 38(2): 176-179.
11.	Al-Himdani S, Din A, Wright TC, et al. The medial sural artery perforator (MSAP) flap: A versatile flap for lower extremity reconstruction. Injury, 2020, 51(4): 1077-1085.
12.	Steel BJ, Mehta D, Nugent M, et al. Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps. Oral Maxillofac Surg, 2023, 27(4): 655-659.
13.	王玨, 劉海峰, 王旭東, 等. 彩色多普勒超聲和CT血管造影技術在下肢穿支皮瓣臨床應用中的對比研究. 組織工程與重建外科, 2021, 17(5): 400-404.
14.	Moore R, Mullner D, Nichols G, et al. Color Doppler ultrasound versus computed tomography angiography for preoperative anterolateral thigh flap perforator imaging: a systematic review and meta-analysis. J Reconstr Microsurg, 2022, 38(7): 563-570.
15.	方軍, 趙光宗, 李華壯, 等. 三維CT血管造影輔助游離腓腸內側動脈穿支皮瓣修復足部創面的療效. 中華燒傷與創面修復雜志, 2023, 39(4): 343-349.
16.	Abdelrahman M, Jumabhoy I, Qiu SS, et al. Perfusion dynamics of the medial sural artery perforator (MSAP) flap in lower extremity reconstruction using laser Doppler perfusion imaging (LDPI): a clinical study. J Plast Surg Hand Surg, 2020, 54(2): 112-119.
17.	Hallock GG. The medial sural artery perforator flap: a historical trek from ignominious to “Workhorse”. Arch Plast Surg, 2022, 49(2): 240-252.

1. 冉小葉, 劉元波, 楊若夢, 等. 穿支螺旋槳皮瓣連續轉移技術在下肢遠端軟組織缺損修復中的臨床應用. 中國修復重建外科雜志, 2022, 36(4): 451-455.
2. 彭平, 董忠根, 魏建偉, 等. 逆行帶蒂腓腸筋膜皮瓣的部分壞死相關因素分析. 中國矯形外科雜志, 2022, 30(8): 673-677.
3. 陳玉兵, 王麗麗. 足背動脈穿支蒂皮瓣修復前足背側皮膚軟組織缺損療效觀察. 中國修復重建外科雜志, 2017, 31(5): 632-634.
4. Mehmood Hashmi P, Musaddiq A, Hashmi A, et al. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Ann Med Surg (Lond), 2021, 73: 103109. doi: 10.1016/j.amsu.2021.103109.
5. 舒景坤, 李紅, 趙連偉. 旋轉點下移的外踝上皮瓣修復足內側皮膚軟組織缺損. 實用手外科雜志, 2021, 35(4): 497-499.
6. 范愛民, 陳燕, 李政, 等. 游離股前外側穿支皮瓣修復足踝部軟組織缺損. 中國矯形外科雜志, 2022, 30(10): 937-939.
7. 徐寶成, 蒙顯晨, 汪金根, 等. 游離腓腸內側動脈穿支皮瓣修復四肢軟組織缺損. 中華手外科雜志, 2022, 38(3): 233-235.
8. 方杰, 陳步國, 吳堯, 等. 腓腸內側動脈穿支皮瓣臨床應用研究進展. 中國修復重建外科雜志, 2021, 35(4): 508-513.
9. Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
10. 楊濤, 趙磊, 宋科, 等. 游離腓腸內側動脈穿支皮瓣對足趾皮膚缺損的美學修復. 中華整形外科雜志, 2022, 38(2): 176-179.
11. Al-Himdani S, Din A, Wright TC, et al. The medial sural artery perforator (MSAP) flap: A versatile flap for lower extremity reconstruction. Injury, 2020, 51(4): 1077-1085.
12. Steel BJ, Mehta D, Nugent M, et al. Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps. Oral Maxillofac Surg, 2023, 27(4): 655-659.
13. 王玨, 劉海峰, 王旭東, 等. 彩色多普勒超聲和CT血管造影技術在下肢穿支皮瓣臨床應用中的對比研究. 組織工程與重建外科, 2021, 17(5): 400-404.
14. Moore R, Mullner D, Nichols G, et al. Color Doppler ultrasound versus computed tomography angiography for preoperative anterolateral thigh flap perforator imaging: a systematic review and meta-analysis. J Reconstr Microsurg, 2022, 38(7): 563-570.
15. 方軍, 趙光宗, 李華壯, 等. 三維CT血管造影輔助游離腓腸內側動脈穿支皮瓣修復足部創面的療效. 中華燒傷與創面修復雜志, 2023, 39(4): 343-349.
16. Abdelrahman M, Jumabhoy I, Qiu SS, et al. Perfusion dynamics of the medial sural artery perforator (MSAP) flap in lower extremity reconstruction using laser Doppler perfusion imaging (LDPI): a clinical study. J Plast Surg Hand Surg, 2020, 54(2): 112-119.
17. Hallock GG. The medial sural artery perforator flap: a historical trek from ignominious to “Workhorse”. Arch Plast Surg, 2022, 49(2): 240-252.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps

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