Clinical Application Of Repairing Heel And Ankle Defect Using Improvement On The Malleolus Medialis Perforators Fascial Flap

Objective: To investigate the clinical efficiency of repairing heel and malleolus wounds with turn-over 180 degrees by medial supramalleolar perforator fascial flap of posterior tibial artery compared with traditional surgery.Method: 61 patients of heel and malleolus wounds combined with tendon or bone exposure were retrospectively analyzed from March 2010 to May 2015,in which 25 patients(the improvement group) were operated with medial supramalleolar perforator fascial flap of posterior tibial artery,12 patients were operated with vascular anastomosis using thoracodorsal artery perforator flap,12 patients were operated with contralateral tibial artery cross leg flaps,12 patients were operated with adjacent sural neurovascular flap.The follow three groups are the traditional group.The following three aspects are compared:(1)during hospitalization indicators include: the number of operations and time, intraoperative bleeding, hospital stay, total hospital costs;(2) ankle function recovery after six months include: walking gait, activity limitations, ankle range of motion, restrictions shoes;(3)quality of life after six months to a year the patient survey include: hypertrophic scars itching, mental deficiency, the daily lives of reoperation requirements.Results: All improvement and traditional operation were successful, no significant complications. Both have the same rate. The average number of operations of the improved group(1.53 times), total operation time [(186.56 ± 44.45) min], total hospitalization time [(13.25 ± 3.48) d], intraoperative bleeding [(88.5 ± 48.6) ml], total hospital costs [(14317.23 ± 1019.34) yuan] was significantly lower than the conventional group [the average number of operations(2.97 times), the total time of operation(252.47 ± 27.21) min, total hospitalization time(27.32 ± 4.49) d, intraoperative bleeding(183.4 ± 33.9) ml, total hospital costs(22563.66 ± 1296.44) yuan,P <0.05].The ankle function score of the improved group[shoes limit(85.23 ±0.34) points, gait(82.57 ± 0.26) points, ankle range of motion(74.81 ± 0.65) points, activity limitations(80.33 ± 0.61) points] was significantly higher than traditional group [shoes limit(52.47 ± 0.55) points, gait(58.77 ± 0.54) points, ankle range of motion(43.11 ± 0.35) points, activity limitations(61.09 ± 0.85) min, P <0.05].The postoperative quality of life of the improved group [hypertrophic scar pruritus(16%), the effect of daily life(20%), mental deficiency(16%), re-operation requirements(4%)] was significantly better than the conventional group [hypertrophic scar pruritus(44%), the effect of daily life(47%), mental deficiency(44%), re-operation requirements(42%),P <0.05].Conclusions: The medial supramalleolar perforator fascial flap of posterior tibial artery with turn-over 180 degrees in repairing heel and malleolus wounds combined with tendon or bone exposure significantly shortens operation duration and decreases the amount of intraoperative bleeding,avoiding repeated surgery, surgical quicker recovery and good shape, recovery function good, fewer complications, and other advantages,improving the shortcomings of traditional surgery such as a large damage area, bloated appearance after the repair,multiple surgeries.