Modified Skin Flaps With Nutrient Vessels Of Superficial Vein ╟ Cutaneous Nerve Of Lower Limb For Repair Of Lower Extremity Soft Tissues Defects

Objective To investigate the modified methods and effects of the flaps with nutrient vessels of superficial vein– cutaneous nerve of lower limb which used for repair of the lower extremity soft-tissues defects. To summarize the experience ,consummate the modus operandi of cutting and using flap gradually, elevate the functional effect of the soft tissue defect and bone revealed in the lower limb and foot-ankle, enlarge the the application scope of flap and reduce the operation complication.Method Between December 2003 and September 2009, 18 patients were treated with this modified skin flap, Register the age,gener,the reason of injury,depth and area of soft tissue defect place,the area of cutting flap,the treatment of small saphenous vein and sural nerve,anastomosis condition of nervus cutaneus,contrivance and displace of pedicle and follow-up visit of the flap.analyze the correlation factor's influence on the take of flap, patient's feeling,function and appearance.reading pertinent literature to explore the improvement method on operation and announcements.Result 18 patients were treated with this modified skin flap, in which 11cases are male; 7cases are female, age from 5 to 73 years. Average age is 45.9 years. Repair parts: 4 cases of dorsal foot, 3 cases of foot, heel in 2 cases, the ankle weeks in 2 cases, calves under 1 / 3 of 7 cases, of which eight cases of bone exposure wounds, tendons exposed in 3 cases. Surgical repair of soft tissue defect size of about 6cm*4cm～22cm*10cm, which retained the donor sural nerve function retrograde sural nerve flap in 4 cases, with a thin layer of muscle retrograde sural nerve flap in 4 cases . All the flaps are survived completely without any complications. The appearance and functional results were satisfactory with following up for 3 to 36 months. 18cases of flap are survived completely, primary healing, without any complications such as vein congestion or engorgement. The 4cases which remains the cutaneous nerve in site have an average recovery time about 13 days of the donor site. The innervated regions of the cutaneous nerve have no acroesthesia or dysesthesia.Conclusion Because of the advantages of sural neurocutaneous flap as the reliable blood supply, lesser injuries for donor area,simple procedure and reconstruction of sensation, it received extensive solicitude both on anatomic and clinic study.but they also had some disadvantages as part feeling lost,bed venous return, neuroma and the recipient area maybe clumsy .We improved the sural neurocutaneous flap as follow : Strengthening the pedicle perforator of the flap and lowering the rotation site of the flap. We designed the sural neurocutaneous flap with thin muscle, in order to eliminate the dead space and increase the resistance infection; we gravitate down the swivel of flap, the cutaneous nerve was retained in the donor site. All in all, we believe following the development of flap surgery, This modified operation methods of flap, enhanced the blood support of the flap, improved the survive rates and also preserved the sensory function of the patients'donor site .This modified flap with nutrient vessels of superficial vein-cutaneous nerve is a convenient and safe method in repairing lower extremity soft-tissues defects.