The Clinical Implication Of Distally Based Saphenous Neurocutaneous Vascular Island Flap

Objective This study is to investigate the clinical effect of distally based saphenous neurocutaneous vascular island flap for the treatment of soft tissue defect of distal lower leg, foot and ankle. This study also aims to summarize the surgical experience, gradually improve the surgical technique of distally based saphenous neurocutaneous vascular flap based on the anatomical characteristics of the blood supply of the flap, and evaluate the functional effect of distally based saphenous neurocutaneous vascular island flap for the treatment of soft tissue defect of foot and ankle. Methods soft tissue defect of foot and ankle in 36 patients was repaired using distally based saphenous neurocutaneous vascular island flap. The information of age, gener, the reason of injury, depth and area of soft tissue defect place, the area of cutting flap, the treatment of great saphenous vein and saphenous nerve, anastomosis condition of nervus cutaneus, contrivance and displace of pedicle and follow-up visit of the flap were carefully recorded. According to the latest clinical and anatomical research of distally based saphenous neurocutaneous vascular island flap, this study is conducted to investigate the surgical technique and precautions of distally based saphenous neurocutaneous vascular island flap for the treatment of soft tissue defect in foot and ankle. Result In our study, there are 25 males and 11 females and the average age is 28.5 years (16-46). All the included patients were diagnosed as exposed bone caused by soft tissue defect of foot and ankle, of which,19 patients are in pure malleolus area defects, nine patients are in medial defect area, four patients are in the medial heel defect and four patients are in the lateral defect. The defect area is 10.0×8.0 cm-15.0×2.0 cm. Of which,14 patients were treated with acute repair and 22 are treated with delay repair. During the follow-up of 6-36 months, four complications were found in our study. Of which, the necrosis of distal edge flap was found in three patients and the scar was healed after dressing. Besides, wound infection was found in one patient and the flap survivaled after local stitches drainage and use of sensitive antibiotics. During follow-up, the flap colour is ruddy and the skin is elasticity wear. In addition, ulcers or severe scar contracture is not found and the function of ankle is well. Conclusion The advantages of distally based saphenous neurocutaneous vascular island flap are easily obtained, anatomical constant, reliable blood supply, large cut area, long organization pedicle, amplitude rotation and so on. However, the disadvantage of it is overstaffed flap, dissatisfied appearance caused by postoperative scar caused and lack of feeling in obtained area or inadequate venous disorders caused by sacrificing a sensory nerve and saphenous vein. In summary, the surgical technique of distally based saphenous neurocutaneous vascular island flap for the treatment of soft tissue defect in foot and ankle is easy and has certain clinical effect.