Clinical Study On Applications Of Modified Sural Nerve Nutrient Vascular Flaps Combined With Vacuum Assisted Closure To Repair Wounds Around Foot And Ankle

Objective To study Clinical outcomes using a modified technique on the lesser Saphenous to increase the venous drainage to repair wounds around foot and ankle by sural nerve nutrient vascular flap(SNVF)combined with VAC(vacuum assisted closure)negative pressure drainage.Methods Retrieve patients who underwent SNVF combined with VAC from September 2013 to June 2017.20 cases which used unique technique on the lesser saphenous were retrieved as modified group,20 cases which unique technique on the lesser saphenous were not performed was retrieved as traditional group,to observe the survival state and compare the rate of complications between the two groups;2.Record VVS scar score of donor sites and Stony-brook scar score of recipient sites,evaluate scar state of all patients after surgeries.3.Record Ankle-Hindfoot Scale and Midfoot Scale score of all patients,compare the foot function score of patients before and after surgeries.Results 1.In the modified group,tension blisters were observed in 1 flap;While in the traditional group,tension blisters were observed in 4 flaps,1 flap turned purple,dark and swollen in 1 case which had healed after the treatment of debridement and pressure dressing 23 days after the operation;the flap in another case was totally lost,the patient was repaired by a delayed surgery of skin graft and was discharged on the 32 nd day after the first surgery;colours and luster of flaps were ruddy and wounds were healed in stage 1(I healing)in the rest of the patients,the average healing time is(12.2±3.04)days.The modified group has lower rate of complications(p value<0.05,difference has significance)than the traditional group.2.The average VVS scar score was(8.51±2.26)in donor sites,;The average Stonybrook scar score was(3.75±1.34)in recipient sites.3.All patients had significant improvement in functional score,and the difference was statistically significant compared with before(P<0.001).Conclusion 1.The modified group which used unique technique on the lesser saphenous get better outcomes than traditional group with lower rate of complications.2.The overall scar state is satisfactory,only partial pigmentation was left in donor sites,scar in recipient sites is inconspicuous with good look.3.Applying SNVF combined with VAC technique to treat wounds around the foot and ankle can improve the joint activity and walking function of the patients.