Microsurgical Reconstruction Of The Soft Tissue Defectson Foot And Ankle

Objective：To explore the clinical effect of free thoracodorsal artery perforator flaptransplantation combined with microsurgical technique for repairing soft tissue defectson foot and ankle and prospect its possible direction for research．Method：We did retrospective research and analysis on clinical cases from January2006to December2013,our department applied free thoracodorsal artery perforators flaptransplantation combined with microsurgical technique to repair soft tissue defect on footand ankle.This group of28patients,of whom22were male and6were female,aged from25to63years.Injured parts:12cases on foot, of which6cases at the bottom of the foot,4cases on the foot heel,and2cases on the back of the foot;8cases on the ankle;8cases onthe foot and ankle.Injured causes:traffic accident injury in12cases,crush injury in6cases,thermal injury in4cases,burns in4cases, chronic ulcer wound in2cases.The areasof soft tissue defects ranged from8cm×5cm to18cm×14cm.The flaps were harvestedfrom9cm×6cm to20cm×15cm in size.10cases of flap area were directly sutured, andother18cases were supplemented by the thick skin free transplantation.All of thecases,15cases of the thoracodorsal artery perforators flap were designed with a smallpart of the latissimus-dorsi,which formed composite flap,and the rest13cases wereimmediately done with thin skin flap repairing operation.Result：All of28cases,of which26cases of the district flaps completely survivedand healed;2cases of flaps turned bruising12hours after operation and survived whenrelieved the flap vein crisis;2cases of flaps appeared tension vesicle,partly dismantledflap suture and survived after processing.Other distal part of flaps necrosis occurred only in2cases,they healed after changing dressings and free skin grafting.All28patients werefollowed up from3months to6months,the appearance of flaps were good,local ulcerwas not occurred, overstaffed was not obvious,and no patients asked for secondary flaprepairing.Most of28patients were satisfied with the recovery of appearance and functionon foot and ankle,almost no effect on wearing shoes and walking.Part of the flapsrecovered restoration of protective sensation,but relative greater individual differencesbetween them.After operation, AOFAS ankle-foot function score for (73.79±3.02)pionts,and the last follow-up score for(84.21±3.12)pionts,function scores increasingly improved,the difference was statistically significant(P<0.05).10cases were directly sutured for thearea,and other18cases were supplemented by the thick skin free transplantation,whichall survived after operation.The concave and deformity of areas for local tissue were notobvious,no obvious pain and discomfort on the humeral back,and all patients couldaccept the influence degree of the donor scar.Conclusion：For the methods of repairing soft tissue defects on foot and ankle,weshould base on the size,depth of the wound and overall nutrition and health condition ofpatients to carry out comprehensive evaluation.The free thoracodorsal artery perforatorflap transplantation combined with microsurgical technique based on perforator flapconception is a good method for repairing soft tissue defects on the foot and ankle,notonly protecte the main arteries and less damage to donor site,but also obviously improvethe appearance and function of district flaps area and provide a good sense of recorveryfor foot,which conformes to the researh and developmental direction of the perforatorflap in plastic surgery.