The Clinical Application Of The Free DIEP Flap In Repairing Foot Soft Tissue Defect

Objective To investigate the clinical effect,of the DIEP flap in repairing foot soft tissue defect.To analyze and summarize the anatomical features,special considerations,advantages&disadvantages and the clinical applic ation value of the deep inferior epigastric artery perforator flap.Methods To review and study the literatures on the correlation research of the deep inferior epigastric artery perforator flap in recent years,including anatomical researches,imaging researcesh and clinical applications,etc.From 2016.10 to 2018.06,there were 23 patients whose feet soft tissue was defected with some important structures exposed.After been allowed,actively carried out early debridement on the dorsal foot wound of the patient,cleared necrotic and inactivated tissues,changed dressing regularly,and prophylactic application of antibiotics to prevent infection.When the wound was in healing,no obvious infection,and seepage,choose the free deep inferior epigastric artery perforator flap to cover back foot wound.The wound ranged from 4.8cm*8.0cm to 11.0cm*16.0cm,and the flap ranged from 6.0cm*9.0cm to 12.0cm*18.0cm,the flap donor site should be directly gathering suture.there was 5 cases anastomotic nerve reconstruction of sensory function during the operation.After the operation,anti-infection,anti-spasm,anti-coagulation and other treatments should be taken.By observing the flap blood supplyelasticity,texture,sensation,scar contracture,foot shape,mobility,abdominal scar,abdominal muscle strength and other conditions.we understood and determined the effects,advantages and disadvantages of free subabdominal artery perforator flap in repairing foot wounds.Results Exclude the interference of other factors,according to the standard set to choose 23 cases caused by trauma patients with foot soft tissue defect.All the donor and areas of the flap healed in the first stage,and one case of the flap showed marginal necrosis,which healed after active dressing change,others healed in the first stage.Regular follow-up fron 6 to 18 months.The donor flaps was sutured directly during the operation,and no obvious scar hyperplasia was found at the healing site.No obvious scar hyperplasia,good abdominal appearance,no obvious swelling and depression,no abdominal abdominal muscle strength weakening,no abdominal and back pain and other conditions.The flaps blood supply good,good elasticity,texture soft,feel good,no scar contracture,plantar appearance is satisfied,the foot has no obvious pain and restricted movement:Among the 5 patients with nerve sensory branches anastomosed intraoperatively,3 patients the sensory recovery of the flap reached S2,2 patients had been to S3,and the protective sensation was restored in 8 patient of the other 18Conclusion The donor area of the inferior abdominal artery perforator flap is concealed and easy to be cut.During the operation,the anterior sheath of the rectus abdominis and rectus abdominis was retained to reduce the injury of the donor area of the abdominal skin flap.If necessary,it can carry the intercostal nerve sensory branch,so that part of the sensory can be repaired.During the operation,the donor area and the recipient area of the skin flap can be operated at the same time to shorten the operation time and reduce the complications caused by the prolonged operation and anesthesia.The inferior epigastrium artery perforator flap has realized the desire of "obtaining the best shape and function of the recipient area with the minimum damage of the donor area",which is in line with the development trend at the present stage and can be widely applied.It is a good choice for repairing the wound surface of the foot soft tissue defect.