Top

Published in:

01-07-2020 | Original Scientific Report

Modified Anterior Tibial Artery Perforator-Pedicled Propeller Flap for Soft-Tissue Coverage of the Ankle and Heel

Authors: Jian Lin, Feng Zhou, Yi-Dan Sun, Ya-Shan Gao, Hai-Zhou Li, He-Ping Zheng, Ying-Fan Zhang, Qing-Feng Li, Patricia J. Ward, Ya-Li Yang, Cai-Yue Liu

Published in: World Journal of Surgery | Issue 7/2020

Abstract

Background

The ankle and heel are challenging regions to reconstruct functionally. Here, we explored the feasibility and clinical outcomes of a modified anterior tibial artery perforator-pedicled propeller flap for the repair of soft-tissue defects of the ankle and heel.

Patients and methods

Between January 2013 and December 2015, 12 patients with soft-tissue defects of the ankle and/or heel underwent reconstructive surgery that included our flap technique. The flaps measured 20 × 8 cm to 7 × 4 cm. A hand-held Doppler was used to identify a proper constant perforator in the distal ankle. In each case, the base of the flap was well preserved. The flap was transposed (180° rotation) to reach and cover the defect.

Results

The average follow-up time was 13 months (10–28 months). We observed good texture matches and contour in all of the flaps. All patients could walk and wear normal footwear. All but one flap survived completely without complications. Partial loss was observed in one patient, and the necrotic region was healed with secondary intention.

Conclusion

Our modified anterior tibial artery free-style perforator-pedicled propeller flap provides a novel option for functional ankle and heel reconstruction.

Level of Evidence

Level IV.

El-Sabbagh AH (2011) Skin perforator flaps: an algorithm for leg reconstruction. J Reconstr Microsurg 27:511–523CrossRef

Kermarrec G, Masquelet AC (2014) Sural flap for coverage of a soft-tissue defect of a leg with an occluded fibular artery: a case report. J Plast Reconstr Aesthet Surg JPRAS 67:729–731CrossRef

Koshima I, Moriguchi T, Ohta S, Hamanaka T, Inoue T, Ikeda A (1992) The vasculature and clinical application of the posterior tibial perforator-based flap. Plast Reconstr Surg 90:643–649CrossRef

Sailes FC, Picarella EA, Walkinshaw MD (2013) Novel perforator imaging utilization for distal lower extremity injury reconstruction. Plast Reconstr Surg 132:484e–485eCrossRef

Tajsic N, Winkel R, Husum H (2014) Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes. Injury 45:469–477CrossRef

Tanaka K, Matsumura H, Miyaki T, Watanabe K (2006) An anatomic study of the intermuscular septum of the lower leg; branches from the posterior tibial artery and potential for reconstruction of the lower leg and the heel. J Plast Reconstr Aesthet Surg JPRAS 59:835–838CrossRef

Taylor GI (2003) The angiosomes of the body and their supply to perforator flaps. Clin Plast Surg 30(331–342):v

Beveridge J, Masquelet AC, Romana MC, Vinh TS (1988) Anatomic basis of a fascio-cutaneous flap supplied by the perforating branch of the peroneal artery. Surg Radiol Anat SRA 10:195–199CrossRef

Dai J, Chai Y, Wang C, Wen G (2013) Distally based saphenous neurocutaneous perforator flap for reconstructive surgery in the lower leg and the foot: a long-term follow-up study of 70 patients. J Reconstr Microsurg 29:481–485CrossRef

10.

Hasegawa M, Torii S, Katoh H, Esaki S (1994) The distally based superficial sural artery flap. Plast Reconstr Surg 93:1012–1020CrossRef

11.

Huisinga RL, Houpt P, Dijkstra R, Storm van Leeuwen JB (1998) The distally based sural artery flap. Ann Plast Surg 41:58–65CrossRef

12.

Jeng SF, Wei FC (1997) Distally based sural island flap for foot and ankle reconstruction. Plast Reconstr Surg 99:744–750CrossRef

13.

Ozdemir R, Kocer U, Sahin B, Oruc M, Kilinc H, Tekdemir I (2006) Examination of the skin perforators of the posterior tibial artery on the leg and the ankle region and their clinical use. Plast Reconstr Surg 117:1619–1630CrossRef

14.

Panagiotopoulos K, Soucacos PN, Korres DS et al (2009) Anatomical study and colour Doppler assessment of the skin perforators of the anterior tibial artery and possible clinical applications. J Plast Reconstr Aesthet Surg JPRAS 62:1524–1529CrossRef

15.

Robotti E, Carminati M, Bonfirraro PP et al (2010) “On demand” posterior tibial artery perforator flaps: a versatile surgical procedure for reconstruction of soft tissue defects of the leg after tumor excision. Ann Plast Surg 64:202–209CrossRef

16.

Schaverien MV, Hamilton SA, Fairburn N, Rao P, Quaba AA (2010) Lower limb reconstruction using the islanded posterior tibial artery perforator flap. Plast Reconstr Surg 125:1735–1743CrossRef

17.

Parrett BM, Winograd JM, Lin SJ, Borud LJ, Taghinia A, Lee BT (2009) The posterior tibial artery perforator flap: an alternative to free-flap closure in the comorbid patient. J Reconstr Microsurg 25:105–109CrossRef

18.

Chang SM, Wang X, Huang YG, Zhu XZ, Tao YL, Zhang YQ (2014) Distally based perforator propeller sural flap for foot and ankle reconstruction: a modified flap dissection technique. Ann Plast Surg 72:340–345CrossRef

19.

Hallock GG (2006) The propeller flap version of the adductor muscle perforator flap for coverage of ischial or trochanteric pressure sores. Ann Plast Surg 56:540–542CrossRef

20.

Hyakusoku H, Yamamoto T, Fumiiri M (1991) The propeller flap method. Br J Plast Surg 44:53–54CrossRef

21.

Adhikari S, Bandyopadhyay T, Saha JK (2012) Anterior tibial artery perforator plus flaps for reconstruction of post-burn flexion contractures of the knee joint. Ann Burns Fire Disasters 25:86–91PubMedPubMedCentral

22.

Chang SM, Zhang F, Yu GR, Hou CL, Gu YD (2004) Modified distally based peroneal artery perforator flap for reconstruction of foot and ankle. Microsurgery 24:430–436CrossRef

23.

Foo TL, Chew WY, Tan BK (2011) Improving the reliability of the distally based posterior tibial artery adipofascial flap with the great saphenous venoneural network. Ann Plast Surg 67:288–293CrossRef

24.

Maki Y, Firrell JC, Breidenbach WC (1997) Blood flow in mobilized nerves: results in a rabbit sciatic nerve model. Plast Reconstr Surg 100:627–633 discussion 634–625 CrossRef

25.

Ozalp B, Aydinol M (2016) Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg JPRAS 69:e205–e211CrossRef

26.

Sahijwani H, Warikoo V, Salunke AA et al (2017) Anterior tibial artery perforator plus flaps: role in coverage of posttumor excision defects around the knee joint and upper leg. Asia-Pac J Oncol Nurs 4:342–347CrossRef

27.

Wang RL, Li N, Jiang CH, Guo F, Su T (2014) Anterior tibial artery perforator flap for reconstruction of intraoral defects. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg 72:804–810CrossRef

28.

Wang CY, Chai YM, Wen G, Han P, Cheng L (2015) Superficial peroneal neurocutaneous flap based on an anterior tibial artery perforator for forefoot reconstruction. Ann Plast Surg 74:703–707CrossRef

29.

Innocenti M, Innocenti A, Ghezzi S, Delcroix L (2017) Achilles region soft-tissue defects: a reconstructive algorithm based on a series of 46 cases. J Reconstr Microsurg 33:S40–S47CrossRef

30.

Cavadas PC, Landin L (2006) Reconstruction of chronic Achilles tendon defects with posterior tibial perforator flap and soleus tendon graft: clinical series. Plast Reconstr Surg 117:266–271CrossRef

31.

Schaverien M, Saint-Cyr M (2008) Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 122:161–170CrossRef

Title: Modified Anterior Tibial Artery Perforator-Pedicled Propeller Flap for Soft-Tissue Coverage of the Ankle and Heel
Authors: Jian Lin
Feng Zhou
Yi-Dan Sun
Ya-Shan Gao
Hai-Zhou Li
He-Ping Zheng
Ying-Fan Zhang
Qing-Feng Li
Patricia J. Ward
Ya-Li Yang
Cai-Yue Liu
Publication date: 01-07-2020
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 7/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05452-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Modified Anterior Tibial Artery Perforator-Pedicled Propeller Flap for Soft-Tissue Coverage of the Ankle and Heel

Abstract

Background

Patients and methods

Results

Conclusion

Level of Evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

Level of Evidence

Please log in to get access to this content

Other articles of this Issue 7/2020

Letter to the Editor: Characteristics of Intestinal Volvulus and Risk of Mortality in Malawi

Surgical Training Throughout Africa: A Review of Operative Case Volumes at Multiple Training Centers

Sex Disparities in the Global Burden of Surgical Disease

The Patients with Hirschsprung’s Disease Who Underwent Pull-Through at Age Less than 1 Year: Longitudinal Bowel Function

Effectiveness and Usage Trends of Hemorrhage Control Interventions in Patients with Pelvic Fracture in Shock

Surgeon Experience with Parental Leave Policies Varies Based on Practice Setting