The Cutaneous Flap Repair Of Soft Tissue Defect In Dorsum Pedis

Objective:To summarize the clinical experience of seven flaps for repairing soft tissue defects in dorsum pedis.To explore the characteristic and clinical indications of these seven flaps repairing soft tissue defects in dorsum pedis.Method:To retrospecte and analyse the information about the clinical application of the flaps for repairing soft tissue defects in dorsum pedis in 68 patients from Auguest 2000 to April 2009.Sural neurocutaneous vascular flaps were used to reconstruct soft tissue defects in 31 cases,flap location:12 flaps located at the partial dorsum medial; 19 flaps located at the partial dorsum lateral,distal pedicled flap location: 14 flaps were nearly the middle metatarsal;17 flaps were beyond the middle metatarsal,10 flaps repaired to the metatarsophalangeal joints,the size of the flaps ranged from 8cm×5.5cm to 20cm×12cm. Fasciocutaneous flaps pedicled with the septocutaneous perforators of the posterior tibial artery were used to reconstruct soft tissue defects in 7 cases,flap location:7 flaps all located at the partial dorsum medial,distal pedicled flap location:6 flaps were nearly the middle metatarsal;one flaps were beyond the middle metatarsal,the size of the flaps ranged from 7cm×5cm to 18cm×9cm.Reversed island flaps pedicled with the posterior tibial artery were used to reconstruct soft tissue defects in 3 cases,3 flaps all repaired soft tissue defect in former dorsum pedis and former planta,their rotating point were all in the 1cm above the malleolus, the size of the flaps ranged from 17cm×9cm to 19cm×14cm.Dorsal neurocutaneous flaps on the foot were used to reconstruct soft tissue defects in 6 cases,the size of the flaps ranged from 4.5×4cm to 7×7cm. Lateral supramalleolar fasciocutaneous flaps were used to reconstruct soft tissue defects in 3 cases;Free flaps were used to reconstruct soft tissue defects in 10 cases,umbilical side flap in 5 cases,anterior lateral femoral flap in 5 cases;Cross-leg flaps were used to reconstruct soft tissue defects in 8cases.The statistics was used to analyze flap location,distal pedicled flap location contributing to the partial necrosis rate of the sural neurocutaneous vascular flap,to compare the three common pedicled flaps for repairing soft tissue defects in dorsum pedis.Statistics analytical method:chi square test.Result:Among 31 sural neurocutaneous vascular flaps,17 flaps survived uneventfully,distal epidermal or superficial necrosis took place in 6 flaps,distal partial necrosis took place in 7 flaps,bulk necrosis took place in only 1 case,11 cases of the wound surfaces healed by dressing change,skin grafting,secondary suture,2 cases of the wound surfaces did not heal.Among 7 fasciocutaneous flaps pedicled with the septocutaneous perforators of the posterior tibial artery,4 flaps survived uneventfully,partial epidermal necrosis took place in 1 flap,distal partial necrosis took place in 2 flaps,whose wound surfaces healed by dressing change,skin grafting.Among 3 reversed island flaps pedicled with the posterior tibial artery,3 flaps survived uneventfully.Among 6 dorsal neurocutaneous flaps on the foot,3 flaps survived uneventfully;distal epidermal necrosis took place in 3 flaps,whose wound surfaces healed by dressing change.Among 10 free flaps,six flaps survived uneventfully, distal partial necrosis took place in 2 flaps,whose wound surface healed by secondary suture,total flap loss took place in 2 cases.Among 8 cross-leg flaps,8 flaps survived uneventfully.64 cases of follow-up after operation ranged from 2 weeks to 29 months,all flaps survived well, there were no relapse of suppuration.Sural neurocutaneous vascular flaps: The partial necrosis rate of the flaps located at the partial dorsum lateral(5.3%,1/19) is lower than that of the flaps located at the partial dorsum medial(58.3%,7/12)(P＜0.05).Reversed island flaps pedicled with the posterior tibial artery,sural neurocutaneous vascular flaps, fasciocutaneous flaps pedicled with the septocutaneous perforators of the posterior tibial artery average flap length are difference(17.5±1.3cm), (12.7±3.2cm),(11.4±3.4cm);average flap width are difference (11.3±2.5cm),(8.8±1.9cm),(6.9±1.7cm).Average flap length and average flap width of the three flaps are followed by decreasing.Conclusion:1.Sural neurocutaneous vascular flap is ideal to repair almost all the soft tissue defects in dorsum pedis,flap for repairing soft tissue defects in the partial dorsum lateral survive more reliable.2.The fasciocutaneous flap pedicled with the septocutaneous perforators of the posterior tibial artery is suitable for small and middle defects located at the medial side of dorsum pedis nearly the middle metatarsal.3.The reversed island flap pedicled with the posterior tibial artery is choice for large defects located at the former dorsum pedis and former planta under certain circumstances.4.Dorsal neurocutaneous flap on the foot is suitable for small defects in dorsum pedis,who had the advantage of thin skin flap and will not affect wearing shoes after operation.