POSTERIOR TIBIAL ARTERY FLAPS FOR LEG AND ANKLE RECONSTRUCTION

Document Type : Original Article

Authors

1 Department of Plastic and reconstructive surgery department

2 Department of Plastic Surgery Faculty of Medicine University of Sohag

3 Department of Plastic and reconstructive surgery department,Menofia University Hospital

Abstract

Defects of the leg, ankle, and Achilles tendon regions still represent a tricky issue in lower limb surgery. Among the several reconstructive possibilities, local propeller perforator flaps have gained popularity in the last decades. The posterior tibial artery perforator flap is one of the most versatile flaps for reconstruction in these regions.
Objectives:
To explore the feasibility and therapeutic effect of the posterior tibial artery perforator flaps for coverage of defects around the ankle, heel and lower third of leg
Methods:
From June 2013 to March 2016 a total number of 15 cases of soft tissue defect on the leg, achilles tendon and ankle area in 13 patients managed by posterior tibial artery perforator flap inShebinElkom Teaching Hospital, SohagUniversity hospital and Menofia University Hospital Follow up was done for at least 6 months with good results.
Results:
A total number of 15 cases of soft tissue defect on the leg, achilles tendon and ankle area in 13 patients managed by posterior tibial artery perforator flap. All flaps healed well with good functional results and acceptable donor site morbidity 
Conclusions
It was concluded that the distally based pedicled posterior tibial artery perforator flap was a reliable, easy, less time consuming, and versatile procedure for covering the defects around the ankle, heel, and lower third a leg.
KEYWORDS: Lower limb reconstruction; achilis and calcaneal regions; Adipofascial flaps; posterior tibial perforators

References

- Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R, Lower Extremity Assessment Project (LEAP) Study Group. Complications following limb threatening lower extremity trauma. J Orthop Trauma. 2009;23:1-6.
2.  Saddawi-Konefka D, Kim HM, Chung KC. A systematic review of outcomes and complications of reconstruction and amputation for type IIIB and IIIC fractures of the tibia. PlastReconstr Surg. 2008;122:1796-805.
 3. Scher KS, Steele FJ. The septic foot in patients with diabetes.Surgery.
4-  Brian M. Parrett, Julian J. Pribaz, Lower Extremity Reconstruction Rev. Med. Clin. Condes - 2010; 21(1) 66 – 75
5- Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region. ScandJ PlastReconstrSurg1983(17): 191–6.
 6- Gumener R, Zbrodowski A, Montandon D. The reverse fasciocutaneous flap in the le PlastReconstrSurg 1990;88(6): 1034–43.
7- Jeng SF, Wei FC, Kuo YR. Salvage of the distal foot using the distally based sural island flap Ann PlastSurg 1999;43(5):449– 505.
 8- Hyakusoku H, Tonegawa H, Fumiiri M. Heel coverage with a Tshaped distally based sural island fasciocutaneous flap. PlastReconstrSurg 1993;93(40):872–6. 9-Carriquiry CE. Heel coverage with a deepithelialized distally fasciocutaneous flap PlastReconstrSurg 1990;85(1):116–9.
 10- Attinger A, Cooper P. Soft tissue reconstruction for calcaneal fractures or osteomielites. OrthopClin North Am 2001;32(1): 135–70.
11- Jefferson Braga-Silva Use of reverse adipofascial flap in cutaneous defects of the distal third of the lower leg, Annales de chirurgieplastiqueesthétique 51 (2006) 63–66
12-   Wee J.T.: Reconstruction of the lower leg and foot with the reverse pedicled anterior tibial flap: Preliminary report of a new fasciocutaenous flap. Br. J. Plast. Surg., 39: 327-337, 1986.
13-   Hong G., Steffens K. and Wang F.B.: Reconstruction of the lower leg and foot with the reversed pedicled posterior tibialfasciocutaenous flap. Br. J. Plast. Surg., 42: 512516, 1989.
14-  Gahhos F.N., Jaquith M. and Hidalgo R.: The extended digitorumbrevis muscle flap. Ann. Plast. Surg., 23: 255262, 1989.
15-  Carriquiry C., Aparecida C.M. and Vasconez L.O.: An anatomic study of the septocutaneous vessels of the leg. Plast.Reconstr. Surg., 76: 354-359, 1985.
16- Wright J.K. and Watkins R.P.: Use of the soleus muscle flap to cover part of the distal tibia. Plast.Reconstr. Surg., 68: 957-962, 1981.
17- Satoh K., Sakai M., Hiromatsu N. and Ohsumi N.: Heel and foot reconstruction using reverse-flow posterior tibial flap. Ann. Plast. Surg., 24: 318-324, 1990.
18- Liu K., Li Z., Lin Y., et al.: The reverse-flow posterior tibial artery island flap: Anatomic study and 72 clinical cases. Plast.Reconstr. Surg., 86: 312-316, 1990.
19- CrenguåaComan, D.M. Enescu, Iulia Iacob, S. Dumitrache, C. Bejinariu, Carmen GiugleaPERFORATORS OF THE CALF ARTERIES-ANATOMICAL STUDY,Modern Medicine. 2014, Vol. 21, No. 3 : 170-175
20- El-Saadi MM, Khashaba AA. Three anteromedialfasciocutaneous leg island flaps for covering defects of the lower two-thirds of the leg. Br J PlastSurg 1990;43:536.
21- Amarante J, Costa H, Soares R. A new distally based fasciocutaneous flap of the leg. Br J PlastSurg 1986;39:338.
22- Carriquiry C, Costa MA, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg.PlastReconstrSurg 1985;76:354.
23- Donski PK, Fogdestam I. Distally based fasciocutaneous flap from the sural region: a preliminary report. Scand J PlastReconstrSurg 1983; 17:191
24-Shimin Chang, Jian Linand Dajiang Song, Posterior Tibial Artery Perforator FlapSurgical Atlas of Perforator Flaps 2016WordPress theme by UFO themes
25-Godina M. Early microsurgical reconstruction of complex trauma of the extremities.PlastReconstrSurg1986: 285-    292.
 26- Thorne C H M, Siebert J W, Grotting J C. Reconstructive surgery of the lower extremity. McCarthy J G(ed); Plastic Surgery. Philadelphia: W.B. Saunders Company 1990: 4029-4092.
27-Gustilo RB, Anderson JT. Prevention of      infection in the treatment of onethousand and twenty-five open fractures of long bones: Retrospective  and Prospective analysis. J bone Joint Surg 1976; 58: 453-458.
28- Gustilo R B, Mendoza R M, and William D N. Problems in the management of type III open fractures: A new classification of type III open fractures. J Trauma 1984; 24: 742-746.
29-Barclay TL, Cardos E, Sharpe DT (1983) Cross leg fasciocutaneous flaps. PlastReconstrSurg 72:843–847 1983
30-Tolhurst DE, Haeseker B, Zeeman RJ .The development of fasciocutaneous flap and its application.PlastReconstrSurg 71:597–606  1983.
31-Jefferson Braga-Silva, Use of reverse adipofascial flap in cutaneous defects of the distal third of the lower leg, Annales de chirurgieplastiqueesthétique 51 (2006) 63–66.
32-Chittoria R MishraFasciocutaneous flaps in reconstruction of lower extremity: our experience Kathmandu University Medical Journal (2004) Vol. 2, No. 4, Issue 8, 344-348
33-Akhtar S, Hameed A. Versatility of the suralfasciocutaneous flap in the coverage of lower third leg and hind foot defects. J PlastReconstrAesthetSurg59:839–845  2006
34-Mathes S, Nahai F. Clinical application of muscles and musculocutaneous flaps. St. Louis, Mosby 1982
35-Fayman MS, Orak F, Hugo B et al. The distally based split soleus muscle flap. Br J PlastSurg 40:20–26  1987
36-Quaba O, QuabaA .Pedicled perforator flaps for the lower limb. SeminPlastSurg 20:103–111  2006
 
37- Rainer C, Schwabegger AH, Bauer T, Ninković M, Klestil T, Harpf C et al. Free flap reconstruction of the foot. Ann PlastSurg 42:595–606 1999
38-Khaled M. El Sherbiny and SherifAbou-Gamrah.Precision in Perforator Based Anterior Tibial Artery Adipofacial Flap by the Use of Color Duplex, Egypt, J. Plast. Reconstr. Surg., Vol. 34, No. 1, January: 31-36, 2010
39-Schaverien M, Saint-Cyr M . Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. PlastReconstrSurg 122:161–170  2008
40-Crenguåa Coman, D.M. Enescu, Iulia Iacob, S. Dumitrache, C. Bejinariu, Carmen GiugleaPERFORATORS OF THE CALF ARTERIES - ANATOMICAL STUDY Modern Medicine. 2014, Vol. 21, No. 3 : 170-175
41-Akhtar, M., Khurram, M.F., Choudhary, R. A.H. Khan and Imran AhmadDistally based posterior tibial artery perforator flap for coverage of defects around the ankle, heel and lower third of leg. Eur J PlastSurg (2014) 37: 547
42-Ioannis A. Ignatiadis, Georgios D. Georgakopoulos, Vassiliki A. Tsiampa, Vasilios D. Polyzois, Dimitrios K. Arapoglou and Apostolos E. PapaloisDistal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients, Diabetic Foot & Ankle 2011, 2: 7483
 
 
 
 
 
 
 
 
 
 
 
 
Sohag Medical Journal
Volume 21, Issue 1
January 2017
Pages 105-112

Files

Share

How to cite

Statistics