Repair The Preitbial Soft Tissue Defect Of The Lower Leg With Skin Flap

Trauma, infection, ulcers and scars, tumor resection often leads to thepretibial soft tissue defect of the lower leg. Because the pretibial part of thelower leg lacks muscle protection, soft tissue is not rich, the skin directly attachsto the front side of the tibia, skin activity and flexibility is poor, easy to crushnecrosis and large area defects, resulting pretibial soft tissue defect and deepbone,muscle, internal fixation exposure, and secondary osteomyelitis,musclenecrosis, and it is difficult to heal and repair, and it is always a tough problemfor clinicians, its rate of morbidity and amputation is higher. The pretibial softtissue defects are reconstructed with skin flaps,can be divided into the localfasciocutaneous flap[1], cross-leg flap[2], pedicled flap, myocutaneous flap andfree flap[3]and so on, its surgical method is more, but it has different advantagesand disadvantages, lacking a standardized treatment principle.Objective: To summarize the clinical experience in the repair of pretibialsoft tissue defect with15kinds of skin flap in66cases, to explore theadvantages and disadvantages of each flap, screening the best way to repair.Meterials and Methods:1997July-2011August, our department fortreatment of pretibial soft tissue defect with a total of66cases used15kinds offlaps: the local fasciocutaneous flap in9cases, the double pedicle flap in3cases,the cross-leg flap in3cases, the soleus muscle flap in2cases, the medial head of gastrocnemius muscle flap in15cases, the lateral head of gastrocnemiusmuscle flap in2cases, the posterior tibial artery perforator flap in3cases, theperforating branch of the peroneal artery retrograde island flap in1case, thesural neurovascular flap in5cases, the anterolateral crural island flap in4cases,the medial malleolus flap in1case, the saphenous artery knee epithelial branchof retrograde fasciocutaneous flap in10cases, the free latissimus dorsimyocutaneous flap in2cases, the free anterolateral femoral flap in5cases, thefree tensor fascia lata flap in1case. Cutting area of6cm×5cm～35cm×10cm。Results：Postoperative follow-up period of6months to3years and4months, mean10months. The flap survived completely in61cases, accountingfor92.4%; the flap tip necrosis in3cases, accounting for4.6%; the flapcompletely necrosis in2cases, accounting for3%. Survival of the flap for repairthe appearance and function of the leg are more satisfied, not bloated, not re-flapplasty. Complete necrosis of the flap in two cases, one case of the freeanterolateral femoral flap, due to insufficient arterial pressure, the vessels of thesecondary injury, anastomotic thrombosis leading to surgical failure. One case ofthe medial malleolus flap, due to venous return obstruction leading to the flapcompletely necrosis. Two cases of stage Ⅱ further local skin flap to be repaired,and the flaps all survived. Tip necrosis of the flap in3cases,1case of local flap,the other two cases of the medial head of gastrocnemius muscle flap, the scopeof3cm×2cm to5cm×3cm, three cases of stage II further local skin grafting,and the flaps all survived.Conclusions:(1) For the small area of the pretibial soft tissue defect, the local fasciocutaneous flap is preferred, its texture is good, it has simpleoperation and high safety.(2) For the medium-sized area of pretibial upper2/3part soft tissue defects, the saphenous artery knee epithelial branch of retrogradefasciocutaneous flap and the medial head of gastrocnemiusmuscle flap ispreferred, especially for bone exposure; and for the medium-sized area ofpretibial lower1/3part soft tissue defects, the sural neurovascular flap ispreferred, the flap is rich in blood supply, anti-infection is strong, the flapfunction and appearance is satisfied.(3) For the big area of the pretibial softtissue defects, the free flap is preferred, especially the use of the freeanterolateral femoral flap.(4) According to the scope of the wound, the bloodsupply, depth and the margin of the organization situation, choosing a simple,safe, reliable, good texture flap is its principle.