| Chapter I The Applied Anatomic Study on posterior tibial Artery Perforator FlapObjective to investigate the anatomic characteristics of the posterior tibial artery perforator flap(PTAPF) , to provide the basis for clinical application of the PTAPF.Methods We selected 6 cases of fresh specimens of adult legs, dissected the specimens perfused red latex through arterial cannula after 48 hours, observed and measured the location, number, distribution, pedicle length, diameter, course of the posterior tibial artery perforator, analyzed the data by SPSS11.0 statistical software.Results In 6 cases, 27 branches posterior tibial artery perforators were identified in medial leg ( 4.5 branches on average) the perforating point of the posterior tibial artery perforators located 3-20cm above the medial malleolus, among of them, their external diameters were 0.9±0.21mm, length of the perforators were (2.62±1.11) cm, the frequency of preforator is 100% at 3～10cm above the medial malleolus ,their external diameters were 0.76±0.13mm, length of the perforators were (1.82±0.71) cm, the frequency of preforator is 100% at 10～20cm above the medial malleolus their external diameters were 1.12±0.08mm, length of the perforators were (3.82±0.50) cm, Medial calf muscle cutaneous vascular space poke through septum or sarcolemma,then the branches of perforator connect each other that format blood vessels chain.Conclusion 1.The perforators appear constantly 3-10cm above the lateral malleolus,the pedicle is short,the diameter is fairly thin,it is suitable to be harvested as reverse island posterior tibial artery perforator flap.2. The pedicle of posterior tibial artery perforators 10-20cm above the lateral malleolus is long,on the originate level the perforators diameter is large,it is suitable to harvest free and island posterior tibial artery perforator flap on it. Chapter II Clinical Application Study of Posterior Tibial Artery Perforator FlapObjective To Investigate feasibility and clinical efficacy of posterior tibial artery perforator flap for repairing small soft tissue defects.Methods Colorful Doppler imagination is applied preoperatively to locate the perforators,design reverse posterior tibial artery perforator flaps on the perforators 3-10cm above lateral malleolous to repair 5 cases of saft tissue defects in the distal part of tibial and posterior part of ankle harvest free posterior tibial artery perforator flaps,on the perforators 10-20cm above lateral malleolous to repair 2 cases of soft tissue defects on the dorsal sites of foot (The posterior tibial artery perforator and its venae comitans are anastomosed with lateral tarsal artery and its venae comitans) .The flaps are raised on the surface of deep fascia ,the great saphenous vein and saphenous nerve is saved;The donor site is closed directly in 4 cases,in3 cases skin grafting is applied.Results In this group,7flaps are harvested,the size ranges from 8cm×3cm to 17cm×5cm,all flaps survive completely except for one flap suffered necrosis 1/3distal part of it ,and the wound is reconstructed in with an terolateral thigh perforator flap,the wound healed primarily .Post-operative follow-up ranges from 6 to 12 moths,The flap,s appearance,texture and color is satisfying,in 1 case the sensation recovered to S3,,in5case the sensation recovered to S2.The motor function and sensation of the donor sites is not affected.Conclusion Posterior tibial artery perforator'sanatomy is constant,its blood supply is good,the posterior tibial artery perforator flap is harvested without containing the main trunk of the posterior tibial artery,deepfascia,great saphenous and saphenous herve. The reverse island posterior tibial artery flapbased on the perforators 3-10cm above the lateral malleous is suitable for ankle and knee soft tissue reconstruction;the free posterior tibial artery flap based on the perforators 10-20cm above the lateral malleous is suitable to reconstruct small superficial soft tissue defects of limbs. |
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