Anatomical Study And Clinical Applications Of Posterior-lateral Peroneal Artery Perforator Flap Of The Calf

Part I Anatomical Study of the Posterior-Lateral Peroneal Artery Perforator of the CalfPurposes:To understand and master the anatomical characteristics of the posterior-lateral peroneal artery perforator of the calf,including number of perforators,location of perforators,vessel OD,length of vascular pedicle,distribution and general flowing order,and to provide the anatomical theoretical basis for the clinical preparation of the peroneal artery perforator flap.Methods:Ten cases of calf were selected as the research object,and latex slurry was injected into popliteal artery to make calf perfusion specimen.The peroneal artery perforator was dissected and various indicators of perforator were recorded in two forms:?1?The calf was divided into three segments?upper,middle and lower segments?for records;?2?Each specimen was numbered from top to bottom according to the order of perforating branch as 1st perforator,2nd perforator,...,N perforator,and was recorded by perforator number.Number and location of peroneal artery perforators,vessel OD,length of vascular pedicle,distribution patterns and potential connections were recorded.After sorting out the data,it was analyzed by SPSS 21.0 software system to obtain the statistical results.Results?1?The total number of peroneal artery perforators was 48,4⁶ in each case,with an average of?4.80±0.79?.The average value of perforator vessel OD was?0.90±0.21?mm and of vascular pedicle length was?6.91±0.55?cm.?2?The perforators were most concentrated in the middle segment of the calf,with a ratio of 56.25%.There were 2³ perforators per case,with an average of?2.70±0.48?perforators per case.The average value of vessel OD and vascular pedicle length in the middle perforator was?1.03±0.12?mm and?7.27±0.32?cm,respectively.Analysis results of two indicators with perforators in three segments:?1?Vessel OD:Vessel OD of middle perforator was larger than that of the upper and lower segments,and there was no significant difference between the upper and lower segments.?2?Vascular pedicle:Vascular pedicle length of middle perforator was larger than that of the upper and lower segments,and there was no difference between the upper and lower segments.?3?There were 10 cases with the1-4^th perforator,6 cases with the 5^th perforator and 2 cases with the 6^th perforator:The vessel OD and vascular pedicle length of the 2^nd perforator were?1.17±0.07?mm and?7.57±0.22?cm,respectively,which were thicker and longer than is the 1^st,3^rd,4^th,5^thh and 6^th perforator.?4?The occurrence rate of two accompanying veins in the peroneal artery perforator was 91.67%,and that of one accompanying vein was 8.33%.Conclusions:?1?The number of posterior-lateral peroneal artery perforator of the calf is constant as 4⁶.The distribution is concentrated in the middle segment of calf.Compared with the upper and lower segments,the middle segment was thicker in vessel OD and longer in vascular pedicle,which is more favorable for vascular anastomosis and is an ideal perforator supply area in clinic.?2?Vessel OD and vascular pedicle of the 2^nd perforator were more ideal than other perforators.It may be preferred when designing peroneal artery perforator flap.Part II Clinical Applications of Posterior-Lateral Peroneal Artery Perforator Flap of the Calf Purposes: Based on the anatomical characteristics of the peroneal artery perforator,the posterior lateral peroneal artery perforator flap of the lower leg was prepared and transplanted to repair the postoperative soft tissue defect of oral cancer,To explore its application characteristics and clinical repair effect.Methods: 15 patients with oral cancer admitted by oral and maxillofacial surgery in The First Affiliated Hospital of Bengbu Medical College from January 2018 to June 2019 were selected,including 3 cases with upper palatal cancer,5 cases with tongue cancer,5 cases with buccal cancer and 2 cases with oral floor carcinoma.There were 14 cases of squamous cell carcinoma and 1 case of adenoid cystic carcinoma after the pathological diagnosis.Before the surgery,15 patients underwent CDU examination of posteriorlateral perforator of the calf and 1 patient with oral floor carcinoma underwent PET-CT examination.The flap was prepared,cut and the lesion was completely removed by two fixed groups of medical staff.Soft tissue defect in oral cavity was repaired with free peroneal artery perforator flap.Routine symptomatic treatment was provided after operation.Through outpatient examination and regular follow-up for 1 year,it focused on patients with intrathoracic flap repair,voice function,swallowing function,opening mouth,calf supply area recovery and prognosis and evaluated the flap repair effect.Results?1?Cut area of flap was 3.0cm×3.0cm⁶.0cm×5.5cm and average area was 4.5cm×3.5cm;the survival rate of 15 cases of flap was 100%,and only one case had vascular crisis,which was saved by timely operation.?2?All surgical incisions were healed in phase I and the movement function of the calf was gradually restored to normal after the direct drawing-stitching in the supply area.15 cases showed good shape of flap and soft texture similar to oral mucosa,showing a tendency of mucosalization;1 case was delayed in healing due to Skin infection and the rest was healed in phase I.?3?The patients with upper palate,tongue,buccal and bottom mouth cancer recovered well after operation,and their speech,swallowing and mouth opening gradually returned to normal;During the follow-up period,there was no recurrence.Conclusions: The application of the posterior-lateral peroneal artery perforator flap of the calf in the soft tissue defect after oral cancer surgery can achieve good clinical repair effect and is a good choice for repairing the intraoral and small soft tissue defects in patients with oral cancer.