Comparison Between Posterior Tibial Arterial Perforator-plus Fasciocutaneous Flap And Perforator-pedicled Skin Flap In Clinical Application

Objective:The purpose of this study was to compare each sort of flap's flap-viability-related complication(be hereafter referred to complication for short)and influential factors and summarize up our clinical experience with using each sort of flap to repair the soft tissue defects of leg,foot and ankle.Methods:To retrospect and analyse the information about the clinical materials and operational photos of 48 patients using posterior tibial artery perforator-plus fasciocutaneous flap(perforator fasciocutaneous group) and 15 patients using posterior tibial artery pedicled perforator flap(pedicled perforator group) from August 2002 to march 2011.The age of the patients ranged from 3-80 years old,the cause of disease leading to soft tissue defects include trauma (37cases),tumor(1 cases),chronic osteomyelitis associated with chronic ulcer(6cases)and sinuses (15cases), chronic ulcer(2cases),unstable scar(2cases),Almost all of the defects associated with exposed bone,joint,and or exposed tendon. The defects repaired by posterior tibial artery perforator-plus fasciocutaneous flap located at upper cnemis(1 case), middle cnemis (2 cases), distal third leg (19 cases), heel and ankle (22 cases), dorsum pedis(4 cases).the distance from turning pivot to the tip of the medial malleolus ranged from 3cm to 14cm,including 32 cases in 3-8cm,16 cases in 9～14cm,the size of flaps ranged from 5cmx4cm to 18cmx9cm.the defects repaired by posterior tibial artery pedicled perforator flap located at upper cnemis(1 case), middle cnemis (1 case), distal third leg (10 cases),heel and ankle(3 cases).the distance from turning pivot to the tip of the medial malleolus ranged from 5-14cm,including 3 cases in 5-6.5cm,12 cases in 9-25cm,the size of flaps ranged from 4.5cmx4cm to 13.5cmx8cm.According to the position of flap's turning pivot,all flaps were divided into turning pivot≥9cm flap and turning pivot<9cm flap;according flap's survival result, flaps ware divided into no complication(completely survived) flap,major complication(partial necrosis) flap,minor complication(include margin necrosis and epidermal necrosis) flap.All the data were statistical analyzed by spss16.0 soft ware.Results:9 in 15 pedicled perforator group completely survived;3 cases with distal partial necrosis,1 was healed after skin-grafting,2 was healed after local flap construction; 1 with margin necrosis,healed after the second satge of suture;2 with epidermal necrosis,healed after dressing change.37 in 48 perforator fasciocutaneous group completely survived,5 cases with distal partial necrosis,1 was healed after the second satge of suture,3 was healed after skin-grafting,1 was healed after local flap construction;2 with margin necrosis,2 with epidermal necrosis.All flaps were followed up for 2 weeks to 52 months (mean,5 months),the appearance of pedicled posterior tibial artery perforator flap was satisfactory,no cat-ear anisotrophy appeared,while the appearance of posterior tibial artery perforator-plus fasciocutaneous flap was not satisfactory,cat-ear anisotrophy appeared in 44 cases of 48 cases.Major complication rate(10.4%),minor complication rate(12.5%) and general complication rate(22.9%) of the perforator fasciocutaneous flap group was lower than pedicled perforator flap group's corresponding index(20%,20%和40),the differences of them were not statistical significance (P>0.05). the turning pivot>9cm flap's major complication rate,minor complication rate and general complication rate in pedicled perforator flap group and perforator fasciocutaneous flap group respectively were (16.7%) and (6.3%),(16.7%) and (6.3%),(33.3%)and(12.5%),they were not statistical significance(P>0.05). the constituent ratioof turning pivot≥9cm flap of perforator fasciocutaneous flap group(33.3%) was lower than pedicled perforator flap group(80%), It was statistical significance (P<0.05).Conclusion:First, compared to posterior tibial artery pedicled perforator flap,the possible tendency of posterior tibial artery perforator-plus fasciocutaneous flap's complication rate was lower;Second,with more beautiful appearance posterior tibial artery pedicled perforator flap should be the preferred choice when the turning pivot of the flap located at 9 cm above the tip of the medial malleolus.