The Correlated Investigation Of Zonation Of Fascia Pedicel And The Area Of The Modified Medial Fasciocutaneous Flap Of The Lower Leg

Objective: To investigate the relationship between the zonation of fascia pedicel and the area when design the modified medial fasciocutaneous flap of the lower leg in the different zonation of the lower leg. To observe the clinical result of the repair of skin defect of the front of the knee, the lower leg, and the ankle with the modified medial fasciocutaneous flap of the lower leg in the different zonation. The patients who have the skin or tissue defect are the subjects. According to the different zonation of the fasciocutaneous flap, the patients were divided into three groups. We investigate the flap area in the different zonations and follow up the healing of flap and the function of the affected limb of patients in order to offer the theory basis and the new clinical treatment.Methods: There are 45 patients of skin defect of the limbs. Firstly, the length of lower leg was divided into three zonations equally. According to the different zonation of the fasciocu- taneous flap, the patients were divided into three groups. A group: There are 8 patients in group A. The swivel of fascial pedicel of each patient is in the upper third of the lower leg. There are 6 flaps which directions of blood supply coincide with the blood supply of the lower legs and 2 flaps which directions of blood supply disagree with the lower legs'. B group: There are 20 patients in group B. The swivel of fascial pedicel of each patient is in the middle third of the lower leg. There are 5 flaps which directions of blood supply coincide with the blood supply of the lower legs and 15 flaps which directions of blood supply disagree with the lower legs'. C group: There are 17 patients in group C. The swivel of fascial pedicel of each patient is in the lower third of the lower leg. There are 6 flaps which directions of blood supply coincide with the blood supply of the lower legs and 11 flaps which directions of blood supply disagree with the lower legs'. The texture, survival size, and color of the flaps were checked up and the function of patient's limb evaluated after the operation (Only evaluates receptor).Results: Forty-three flaps survived totally. There was partial necrosis in 2 cases. There were 3 cases which distal parts of flaps show the vein articulo after operation. But the flaps survived totally for the symptomatic treatment in time. The follow-up ranged from 5 months to 2 years postoperatively with a mean of 7 months. It showed satisfactory results functionally and cosmetically.Conclusions: 1 Swivel point of fascial pedicel is random on the line that is from the tuberosity of tibia to the inner malleolus. The scope of the repair expands. 2 The flap is cutted without the exposure of the branches of posterior tibial artery and the sacrifice of the main artery. There has the different survival size of flap, when the swivel point of fascial pedicel is in the different zonation. (1) When the swivel of fascial pedicel of patient is in the upper third of the lower leg, because of the saphenous branch of the arteria genu suprema which is one of the arteries constituted the blood chain of the lower leg, the flaps which directions of blood supply coincide with the blood supply of the lower legs'are the first choice. The survival sizes of the flaps designed like this are bigger than those which directions of blood supply disagree with the lower legs'. The blood supply of these is more reliable. When the saphenous branch of the arteria genu suprema is damaged, the flap which direction of blood supply disagrees with the lower legs'is the inferior choice. The flap which directions of blood supply disagrees with the lower legs'is supplyed by the branches of posterior tibial artery that almost appear in the middle third or the lower third of the lower leg. As a result, the survival size of flap which directions of blood supply disagree with the lower legs'is smaller. In order to ensure the blood supply the bigger the area of flap is, the more widen the fascial pedicel is. (2) When the swivel of fascial pedicel of patient is in the middle third of the lower leg , whether flaps which directions of blood supply disagrees with the lower legs'or the flaps which directions of blood supply coincide with the blood supply of the lower legs are both good choice. There are many perforating branches of the posterior tibial artery in this zonation. The posterior tibial artery and the arteria saphena coincide with each other in the middle third of the lower leg. So, the range of the flap is from the superior margin of the whirbone to the ankle. (3) When the swivel of fascial pedicel of patient is in the lower third of the lower leg, whether flaps which directions of blood supply disagrees with the lower legs'or the flaps which directions of blood supply coincide with the blood supply of the lower legs are both good choice. Like the middle third of the lower leg, there are many perforating branches of the posterior tibial artery in this zonation. The blood supply is reliable. During the course of the flap's design, the middle third or the lower third of the lower leg is the first choice. The range of the flap is from the superior margin of the whirbone to the ankle.