Treatment Of Kid Foot Soft Tissue Defect With Reverse Flap With Cutaneous Branch Of Fibular Artery Combine With Sural Nerve Nutritional Vessel Axial

Objective: To investigate the clinical efficiency of kid foot soft tissue defect with reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial. To observe the clinical result of the repair of kid skin defect of the front of the foot, the lower leg, and the ankle with the reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial in the different zonation. According to the position and size of the soft tissue defects, the sural nerve nutritional vessel flap combine with the cutaneous branch of the peroneal artery were desingned and obtained to repair the soft tissue defects of the foot. 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 in the kid foot soft tissue defect.Methods: Firstly, the length of malleolus lateralis to calcaneal was divided into three zonations equally. According to the different zonation of the reverse flap with cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial, the patients were divided into three groups. cutaneous branch of fibular artery general have 4-8 branches.including 3 biggest branches called downside the caput fibulae about 9cm,15cm,20cm.which come onto skin. The original diameter of vessel is about 0.6-1.0mm,length of vessel into muscle is about 4-5cm.in this area both cutaneous branch of fibular artery and sural nerve nutritional vessel axial have much cross-over branches.which also have rich blood supplyment.It is about upside malleolus lateralis 2-15cm,we divide this area into 3 parts which called up,middle,dowm-3areas.A group: calcaneal and plantar soft tissue defect 9 cases . circumvolve point of the flap all together have in down third of cutaneous branch area,which above 2-15cm malleolus lateralis . B group: malleolus lateralis and backside foot tissue defect 8 cases circumvolve point of the flap all together have in middle third of cutaneous branch area,which above 2-15cm malleolus lateralis C group: proximal of backside foot soft tissue defect 8 cases circumvolve point of the flap all together have in upper third of cutaneous branch area,which above 2-15cm malleolus lateralis. All flap are reverse flap. Select two axises:â‘ The line which connect the middle of poplitea area with the middle of which join malleolus lateralis with tendo calcaneus.general speaking upside about 5cm to 7cm malleolus lateralis is the axis point , circumvolve point of the flap is not lowly downside the malleolus lateralis about 5cm.because this flap uses cutaneous branch of fibular artery combine with sural nerve nutritional vessel axial,designing circumvolve point of the flap can reach ankle level.â‘¡The line which connect caput fibulae with malleolus lateralis. Upside exterior ankle about 5cm-10cm is a point which trun out cutaneous branch of fibular artery.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: 25 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 Combined distal flap should expose local cutaneous branch of fibular artery in the malleolus lateralis. But this flap do not expose more parts that close proximal deep main fibular artery.It is also aviod damending deep tissue.2 Because this flap uses combined distal pedicel.It is not only make some local cutaneous branch of fibular artery for the circumvolve point. It is also aviod otherness of the location of cutaneous branch.This flap can provide steady blood nutriton. Meanwhile this flap has two blood provided systems,it is enlarge the range of blood nuitrition.It is could repair soft tissue defect of the distal ankle joint.For example proximal plantar or level of tarsometatasal joint,which repair more range. It is should adapt kid largeness soft tissue defect.3 Flap take in sural nerve,which suture into cutaneous nerve of the ankle It is should resume some parts of sensation of kid ankle skin.4 Combined distal pedicel design simple,It is less expose main artery, moreover which have beauty appearance,not overstaff,It is would adapt develop in the base hospital.