Clinical Application Of Surgical Flap In Repairing Skin And Soft Tissue Defects Of Leg And Foot After High Energy Trauma

Objective:To investigate the clinical application of six kinds of surgical flaps in repairing skin and soft tissue defects of the lower leg and foot after high energy trauma,and to summarize the flap selection,anatomical basis,advantages and disadvantages,cutting techniques and clinical effects of the six kinds of skin flaps.Methods:From September 2015 to September 2019,121cases of soft tissue defects of legs and feet caused by high energy trauma were retrospectively analyzed,including 71 cases of 3 kinds of free flaps and 50cases of 3 kinds of pedicled flaps.Free anterolateral thigh perforator flap was used to repair skin and soft tissue defects in 35 cases.Wounds were located in 8cases of anterolateral leg,9 cases of posterior leg and 18 cases of dorsal foot.Free inferior epigastric artery perforator flap was used to repair skin and soft tissue defects in 21 cases,including 11 cases of posterior leg and 10 cases of dorsal foot.Free superficial circumflex iliac artery perforator flap was used to repair skin and soft tissue defects in 15 cases,including 5 cases at the anterolateral leg and 10 cases at the ankle and back of foot.Three kinds of pedicled flaps were used in 50 cases and sural neurovascular flaps were used to repair wounds in 22 cases,of which 14 cases were located at the lateral malleolus and dorsolateral foot,and 8 cases were located at the middle and lower leg.Skin flap pedicled with perforating branch of posterior tibial artery was used to repair 19 cases of wounds,including 9 cases of leg wounds,5 cases of medial malleolus and dorsum pedis,and 5 cases of lateral malleolus and dorsum pedis.Nine cases of distal exposure of fibula in lateral malleolus were repaired with vascular pedicle of perforating branch of superior lateral malleolus artery.Statistical analysis was carried out on the free group and the pedicled group.The measurement data were subjected to normal distribution test.The measurement data were expressed by x±s and t test.The counting data were tested by X~2 test,p<0.05,and the difference was statistically significant.Results:71 cases of the 3 kinds of free flaps survived successfully in 62 cases,2cases of anterolateral thigh perforator flap and 1 case of superficial circumflex iliac artery perforator flap developed arterial crisis on the first day after operation.The flap survived after the crisis was removed by surgical exploration.One case of anterolateral thigh perforator flap was cut in a range of 19.5cm×15.5cm,and one case of superficial circumflex iliac artery perforator flap was cut in a range of 17cm×12cm.The distal end of the flap was partially necrotic and the wound healed after dressing change.2 cases of perforator flap of inferior abdominal artery,1 case of anterolateral thigh perforator flap and 1 case of superficial circumflex iliac artery perforator flap suffered from serious bleeding on the first day after operation,and the flap survived after operation exploration.Three kinds of pedicled flaps were successful in 48 cases,and 2 cases of posterior tibial artery perforator flaps showed arterial crisis on the second day after operation due to compression of vascular pedicle,which were relieved after surgical exploration.Follow-up for 4 weeks to 12 months showed that the donor site of the flap healed well without obvious ulcer and infection symptoms.The shape of the flap was similar to the recipient site and the texture was soft.The free group was slightly bloated compared with the pedicled group,and there was no significant difference in gender,age,cause of injury and location of injury between the free group and the pedicled group(P>0.05).The cut area of free group was larger than that of pedicle group(P<0.05).The average operation time and intraoperative blood loss in pedicle group were less than those in free group(P<0.05).There was no significant difference in postoperative complications between free group and pedicle group(P>0.05).Conclusion:1.The anterolateral thigh perforator flap,inferior epigastric artery perforator flap and superficial circumflex iliac artery perforator flap have concealed donor sites and constant perforating branches,which are suitable for repairing large soft tissue defects of lower leg and foot.At the same time,they can carry multiple perforating branches to form paging flaps or chimeric flaps.2.The sural neurovascular flap,the posterior tibial artery perforator flap and the lateral supramalleolar artery perforator flap,three kinds of pedicled transfer flaps of the lower leg do not need anastomosis of blood vessels and have strong operability.They are suitable for repairing small soft tissue defects of the lower1/3 segment of the lower leg and the foot.3.Compared with the pedicled group,the free flap has flexible design and wider indications,and the average cutting length and width as well as the cutting area are larger than those of the pedicled group.4.Compared with the free group,the pedicled flap has less operation time,strong operability and easy implement.