| Objective: To investigate the effectiveness of the distally based sural neurocutaneous flap(DSNCF)for repairing soft-tissue defects of ankle and foot,And to explore the clinical effect of selective ligation of the distal lesser saphenous vein(LSV)of the flap pedicle with applied anatomical studies of the LSV.Methods:(1)Anatomically,Anatomy of 30 adult lower extremity specimens,focusing on observing the distribution and source of LSV and its accompanying nutritional vessels near the vascular axis of DSNCF,and the the relationship between the accompanying nutritional vessels of sural nerve and LSV.(2)A total of 55 patients who used DSNCF to repair soft tissue defects of the foot and ankle between July 2010 and July 2019 were collected from our hospital,including 39 male patients and 16 female patients.The average age of these patients was 36.4 years(7 to 69years).The size of DSNCFs ranged from 6.0cm × 3.0cm to 16.0cm × 9.5cm.Among them,28 cases with selective ligation of the distal LSV were divided into the modified group,and 27 cases without special treatment of the distal LSV divided into the traditional group.To observe the blood circulation,swelling and survival of the flaps closely and compare the rate of complications between the two groups,which statistical analysis was performed.The shape,function and sensation of flaps were followed up.Results:(1)Anatomical study: LSV runs closely with the sural nerve in the superficial fascia.On the location of 3.4 ± 0.9 cm above the tip of the lateral malleolus,there are two to three communication branches between the LSV and deep veins.There are several intermuscular septum perforating branches of peronal artery and the terminal perforator branches peroneal artery within 7cm above the tip of the lateral malleolus,and they issued venous nutrition branches correspondingly which constitute the side vascular chain of the LSV and the venous wall vascular network.those venous nutrition branches pass through the sural nerve into the nerve-venous space,and then send out many small nourishing blood vessels which forming a nerve-venous space vascular network.(2)Clinical study: Postoperative 55 cases all transplanted tisssues survived 43 cases(78.18%),and 12 cases(21.82%)had different degrees of complications,which Scars healed after active dressing change or skin graft treatment.Among them,25 patients in the modified group survived completely,1 patient developed tension blisters,and 2 patients developed distal surface necrosis;18 patients in the traditional group survived completely,4 patients developed tension blisters or swelling,dark purple,and 5 patients developed distal surface or deep necrosis.After 9 to 16 months of followed up,all wounds were effectively covered,DSNCF had good appearance and texture,no local ulceration and sinus tract,the appearance of the donor valve area was good,wearing shoes and walking gait Affected,the flap gradually recovered feeling.There was no difference in gender,age,wound bacterial culture,flap area and flap aspect ratio between the modified group and the traditional group(P value> 0.05,difference has no significance);The rate of complications in the modified group was lower than that in the traditional group(P value<0.05,difference has significance).Conclusion: Applying DSNCF to repair the soft tissue defect of the foot and ankle is an ideal surgical option,especially when the tendon and bone are exposed,the flap is easy to apply and the repair effect is reliable;LSV runs closely with the sural nerve,and the branches of its nutritional branchs constitute the nerve-venous vascular network,the side vascular chain of LSV and the venous wall vascular network,so it should be properly handled during surgery to avoid damaging the vascular network;After the flap was formed and the proximal LSV was cut off,LSV should be selectively ligated near the axis of the flap according to the tension of the LSV in the pedicle,the selective ligation of the distal saphenous vein group has a lower complication rate than the traditional group,which can effectively improve the venous congestion of the flap and improve the reliability of the flap. |
