Anatomical Study And Clinical Application Of Supercharged Peroneal Artery Perforator Propeller Flap

ObjectiveTo crystallize the position,numbers,distributions and directions of perforators of the peroneal artery,and the relative position and association of the sural nerve bundle and the peroneal artery in the lower third of the calf.To explore the preliminary clinical effect of supercharged peroneal artery perforator propeller flap for repairing soft tissue defect of foot and ankle.On this basis,compared with the original peroneal artery perforator flap and the sural neurovascular flap,the repair effect was compared.and the supercharged peroneal artery perforator propeller flap in reducing the distal necrosis rate of the flap was further studied.MethodsFrom November 2016 to May 2017,the research team dissected 5 fresh human calf specimens.To observe the anatomical relationship between the perforating site of the peroneal artery and the sural nerve and its accompanying vascular vessels in the lower third of the calf.Exploring the traffic branch vessels between the sural neurovascular and the perforating branches of the peroneal artery.With the perforator of the peroneal artery as the rotation point.the sural nerve pedicle was gradually separated from the distal end of the flap to the rotation point,and the supercharged peroneal artery perforator propeller flap was designed with different perforating branches and different lower limb specimens.After the flap was cut,the effect of different rotation directions on the vascular tension of the double pedicle was observed.A total of 66 patients with soft tissue defects of the foot and ankle were included in the clinical study,and and 10 of them were repaired with supercharged peroneal artery perforator propeller flap.The preliminary clinical effect of supercharged peroneal artery perforator propeller flap was summarized.The other 35 cases of sural neurouascular flap and 21 cases of peroneal artery perforator propeller flap were statistically analyzed in terms of surgical repair effect and postoperative complications.ResultsThe connecting line of peroneal artery perforating and the sural nerve bundle intersect about 3-5 cm above the lateral malleolus.At the distal end of the junction,the sural nerve bundle are slightly ahead.At the proximal end of the junction,the sural nerve bundle are found on the posterior medial side.The peroneal artery perforating vessels and the sural nerve bundle have the traffic branch that can be seen under the microscope.When the peroneal artery perforator about 2.5cm above the lateral malleolus of the left foot was used as the rotating point,the supercharged peroneal artery perforator flap was designed.The flap was rotated 180°,and the double pedicle blood vessel tension is smaller when rotated counterclockwise.When the 5-7cm perforating branch of the left foot is used as the rotation point,double pedicle blood vessel tension is smaller when rotated clockwise.When the peroneal artery perforator of 2.5cm above the lateral malleolus of the right foot was taken as the rotation point,the flap was rotated 180 degrees,and the blood vessel tension of the double pedicle was smaller when rotated clockwise..When the 5-7cm perforating branch of the right foot is used as the rotation point,double pedicle blood vessel tension is smaller when rotated counterclockwise.All 10 cases of supercharged peroneal artery perforator propeller flaps survived and no venous congestion and partial necrosis occurred at the distal end of the flap.Two of the patients had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.35 cases of sural neurovascular flap and 21 cases of peroneal artery perforator propeller flap survived,among which 10 cases of sural neurovascular flap and 5 cases of peroneal artery perforator propeller flap with venous congestion and partial necrosis of flap.There were no statistically significant differences in gender,age,flap size,operative time,bleeding volume,postoperative complications,and AOFAS scores at 3 months postoperatively of two groups.There was a significant difference in the skin grafting rate(65.70%vs 33.33%)in the donor area(P=0.019)ConclusionsIn this study,a second blood supply system was provided by the sural nerve bundle for the perforating flap of the peroneal artery,which is the peroneal artery perforating propeller flap with supercharging technique.The positional relationship between the sural nerve bundle and the peroneal artery perforator vessels determines that the supercharged peroneal artery perforator propeller flap with different planes can only be rotated in different directions to reduce the mutual compression of the double pedicle.Thus,the distal necrosis rate of the flap was reduced.The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis,and has a good clinical repair effect.