Clinical Application Of The Reversed Island Flap Pedicled With The Posterior Tibial Artery And The Fasciocutaneous Flap Pedicled With The Septocutaneous Perforators Of The Posterior Tibial Artery

Objective: To summarize the clinical effect and surgical experience of the reversed island flap pedicled with the posterior tibial artery and the fasciocutaneous flap pedicled with the septocutaneous perforators of the posterior tibial artery. To explore the advantage and disadvarntage of the two flaps and their clinical indications.Method: During Aug. 2002 and Apr. 2007, 11 reversed island flaps pedicled with the posterior tibial artery were performed. The defects located at the medial side of the middle and lower segment of the leg in 4 cases, at the heel in 2 cases, at the middle and distal segment of the thenar or the dorsum of the foot in 4 cases, and at the stump of the forefoot in 1 case. One flap was given up because of the absence of the posterior tibial artery after dissecting, the posterior tibial artery was ligated 1-2cm proximal to the the septocutaneous perforators in the middle segment of the leg in the 10 cases(three cross leg flaps included). Sensation reconstruction was performed in the three flaps transferred to the weight bearing area of the thenar, and anastomosis between the great saphenous vein and the lesser saphenous vein proximal to the defect was performed in one case. The maximal area of the flap was 19cm×14cm, and the minimum was 16cm×8cm. 20 fasciocutaneous flaps pedicled with the septocutaneous perforators of the posterior tibial artery were performed. The defects located at the medial side of the middle and lower segment of the leg in 6 cases, at the medial malleolus in 7 cases, at the achilles tendon area in 4 cases, and at the medial side of the thenar or the dorsum of the foot in 3 cases. All the flaps were elevated by the antegrade-retrograde combined dissection, that is to expose the vessels at the fascial pedicle in the beginning, and then elevate the flap retrogradely. The maximal area of the flap was 18cm×9cm, and the minimum was 5．5cm×4．5cm.Result: Eight of the ten revered island flaps pedicled with the posterior tibial artery survived uneventfully; necrosis took place in the distal part in two flaps, which healed after changing dressings daily and secondary suturing, respectively. The follow up period ranged from 1 month to 23 months in the 10 cases, all the flaps were well, protective sensation of pain and touch was partly regained in the three flaps that has gone through the procedure of sensation reconstruction. Fifteen of the twenty fasciocutaneous flaps pedicled with the septocutaneous perforators of the posterior tibial artery survived uneventfully; marginal necrosis took place in 4 flaps, among which three healed after changing dressings daily, and one healed after secondary suturing; major necrosis took place in one flap, which healed after dermaplasty. The follow up period ranged from 1 month to 25 months in the 20 cases, and all the flaps were well. Conclusion: 1 The area of the the reversed island flap pedicled with the posterior tibial artery is relatively large and the flap can have sensation reconstruction, it is especially suitable for defects located at the forefoot, and large defects located at the medial side of the middle and lower segment of the leg, at the foot and the malleolus.2 The posterior tibial artery is ligated 1-2cm proximal to the septocutaneous perforators in the middle segment of the leg in the reversed island flap pedicled with the posterior tibial artery, which is simple and shortcut to perform and will cause little damage to the leg and do no harm to the survival of the flap.3 The fasciocutaneous flap pedicled with the septocutaneous perforators of the posterior tibial artery need not sacrifice the trunk of the posterior tibial artery, and is easy to perform, which makes it especially suitable for defects located at the medial side of the middle and lower segment of the leg, the medial side of the foot and the medial malleolus.