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Hashmi PM, Ahmed K, Ali M, Musaddiq A, Hashmi A, Nawaz Z. Lateral supramalleolar flap: Is it based on perforator of peroneal / anterior tibial artery; A cross-sectional study at tertiary care centre. Ann Med Surg (Lond) 2021; 71:102916. [PMID: 34754445 PMCID: PMC8556601 DOI: 10.1016/j.amsu.2021.102916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/02/2022] Open
Abstract
Background To determine the anatomical basis of supramalleolar flap; retrograde versus antegrade and its clinical outcome based on the vascular pattern. Methods This analytic cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients who underwent coverage of soft tissue defects around the foot and ankle with supramalleolar flaps were included. Data collection was through medical records including demographic parameters, mechanism of injury, per-operative findings of perforator origin, and patient interviewing for final assessment. Patients with peripheral vascular disease, unavailability of skin, and radiation injuries were excluded. All analysis was done using SPSS version 25.0. Results 49 patients were included in the study from May 1999 to December 2020. The male to female ratio was 37:12. The cause of soft tissue defects was trauma in 9 (38.7%) followed by Infection in 16 (32.6%) and Blast injury in 5 cases (10.2%). The maximum flap size harvested was 20 × 8 cm. In 19 cases the peroneal artery perforator was absent and the flap was based on the perforator of an anterolateral malleolar branch (antegrade) while the remaining 30 flaps were based on the perforator of the peroneal artery (retrograde). Overall, the flap survival rate was 98%; as 1 case had partial necrosis and required skin grafting. However, there were 9 minor complications. In 8 patients, the flap was rotated as a 'delay flap' . All patients had satisfactory functional outcomes without significant morbidity of the donor site. Conclusion The lateral supramalleolar flap provided coverage to almost all regions of the foot and ankle with a cosmetically acceptable donor and recipient site. There were no problems with shoe wear, as only 2 patients required defatting for cosmetic reasons. Microvascular expertise was required for a predictable outcome.
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Affiliation(s)
| | | | | | | | | | - Zohaib Nawaz
- Aga Khan, University hospital, Karachi, Pakistan
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Taman E, Ragab A, Khereba W, Attia K, Alshafey EO, Shoab SS. Single-Stage Vascular Repair and Tissue Cover in Complex Ankle Injuries. Ann Vasc Surg 2019; 61:467.e11-467.e16. [PMID: 31377391 DOI: 10.1016/j.avsg.2019.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 11/25/2022]
Abstract
Infragenicular arterial trauma with associated soft-tissue defects presents a challenging scenario. Vascular reconstruction along with concurrent tissue cover may be necessary. We present our experience with six vascular injuries with associated tissue loss. There were 3 male and 3 female patients (age range: 4-60 years). Minimum follow-up was for 12 months. All patients survived with satisfactory coverage of the defect. There was one partial necrosis treated conservatively. Satisfactory limb function was observed in all patients. Thus, these injuries may be treated by simultaneous vascular repair and local flap cover. This may help prevent postoperative infection and save the limb.
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Affiliation(s)
- Essam Taman
- Plastic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt; Vascular Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt
| | - Almetwaly Ragab
- Plastic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt; Vascular Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt
| | - Walied Khereba
- Plastic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt; Vascular Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt
| | - Khaled Attia
- Plastic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt; Vascular Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt
| | - Elghareeb Osman Alshafey
- Plastic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt; Vascular Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, New Damietta, Egypt
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Gaillard J, Bourcheix LM, Masquelet AC. Perforators of the fibular artery and suprafascial network. Surg Radiol Anat 2017; 40:927-933. [PMID: 28936687 DOI: 10.1007/s00276-017-1927-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Soft tissue defect on lower limb can result in an intractable wound. Surgeons resort in flaps to cover these injuries. Including fascia as in the case of a fasciocutaneous flap increases survey of the flap. Rising a perforator flap avoids to sacrifice a major vessel whence the nourishing perforator artery is born. We wanted to explore suprafascial distribution of the fibular skin perforator arteries supposing possible to find out a vascular axis composed of anastomoses of the fibular perforator vessels. MATERIALS AND METHODS Systematic observation was carried out on ten injected legs about the fibular perforator distribution, and especially their suprafascial course. RESULTS Dissection allowed us to raise in all specimens a large fasciocutaneous paddle including a fine arteriolar vessel connecting fibular perforators. Perforators were isolated along from the leg and we found suprafascial arteriole connecting all perforators from the fibular head to the lateral malleolus. There were a total number of 126 perforators for 10 legs. The mean length of the fibula was 32.9 cm. No perforator was located at more than 2 cm from fibular posterior border. Proximal perforators were closer to posterior fibular side than distal perforators. We found that fibular perforators clustered in the middle and upper third of the leg. CONCLUSION This study proves the real existence of a microvascular suprafascial axis formed by fibular perforator anastomoses and stretching over the entire length of the fibula, from the fibular head to the distal tip of the lateral malleolus. This suprafascial vascular axis could be an anatomical basis for a fasciocutaneous fibular flap.
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Affiliation(s)
- Julien Gaillard
- Laboratory of Anatomy, School of Surgery, Assistance Publique des Hôpitaux de Paris, 7 rue du Fer à Moulin, 75221, Paris cedex 05, France. .,Department of orthopaedic, traumatology and reconstructive surgery, Hôpital Saint-Antoine, 184, rue du Fg Saint Antoine, 75571, Paris, France. .,Groupe Hospitalier Paris Est, Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Laurent-Marie Bourcheix
- Laboratory of Anatomy, School of Surgery, Assistance Publique des Hôpitaux de Paris, 7 rue du Fer à Moulin, 75221, Paris cedex 05, France.,IFCM-Institut Français de Chirurgie de la Main, 5 Rue du Dôme, 75116, Paris, France
| | - Alain-Charles Masquelet
- Laboratory of Anatomy, School of Surgery, Assistance Publique des Hôpitaux de Paris, 7 rue du Fer à Moulin, 75221, Paris cedex 05, France.,Department of orthopaedic, traumatology and reconstructive surgery, Hôpital Saint-Antoine, 184, rue du Fg Saint Antoine, 75571, Paris, France.,Groupe Hospitalier Paris Est, Assistance Publique des Hôpitaux de Paris, Paris, France
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Li SJ, Cheng H, Fang X, Xu JY, Wang F, Liu S, Chen XL, Lv XW. Modified reversed superficial peroneal artery flap in the reconstruction of ankle and foot defects following severe burns or trauma. Burns 2017; 43:839-845. [PMID: 28041753 DOI: 10.1016/j.burns.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/09/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Challenges persist in the reconstruction of the ankle and the foot with exposed tendons, joints, and bones as a result of severe burns and trauma. In flap elevation involving the sensitive superficial nerve, the local nerve was always sacrificed to obtain an anesthetic donor site; however, such a procedure introduced the possibility of painful neuromas. In this study, we present a desired clinical application of a modified reversed superficial peroneal artery flap, in which the superficial peroneal nerve is preserved. METHODS From 2008 to 2015, 12 patients with ankle or foot defects were treated with the modified reversed superficial peroneal artery flap. The defects of the patients were caused by hot liquid scald (one patient), electrical injury (five patients), and trauma (six patients). The flap was utilized for covering defects on the ankle (seven patients) and the foot (five patients). The size of the flaps ranged from 4.0cm×6.0cm to 18.0cm×10.0cm. The superficial peroneal artery was involved in the flap, whereas the superficial peroneal nerve was spared by dedicate dissection. The reverse-flow flap was nourished by the superficial peroneal artery through the terminal peroneal artery perforator. RESULTS The obtained outcomes were satisfactory functionally and aesthetically. The flaps in 11 patients survived completely without complications, whereas partial necrosis occurred in a 78-year-old patient when the flap survived a week later during follow up. CT angiography revealed the stenosis of the popliteal artery. The wound healed after interventional treatment involving placing a stent and changing the dressings. Basic functions and configurations were salvaged in all cases. All patients were completely satisfied with the proposed flap and suffered no paresthesia in their lower leg. CONCLUSION Exhibiting beneficial characteristics such as reliable blood supply, favorable thickness, wide rotating arc, and retention of major vessels and the superficial peroneal nerve, the modified reversed superficial peroneal artery flap is useful in the reconstruction of ankle and foot defects that would not cause any hypoesthesia of the foot.
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Affiliation(s)
- Shi-Ji Li
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Hao Cheng
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Xu Fang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Jian-Yang Xu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Fei Wang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Sheng Liu
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China
| | - Xu-Lin Chen
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China.
| | - Xiong-Wen Lv
- School of Pharmacy, Anhui Medical University, Mei Shan Road, Hefei, Anhui 230032, China; Institute for Liver Disease of Anhui Medical University, Mei Shan Road, Hefei, Anhui 230032, China.
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Portilho PO, Leite TFDO, Cardoso R, Pires LAS, Silva JG, Chagas CAA. Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries. J Vasc Bras 2016; 15:234-238. [PMID: 29930595 PMCID: PMC5829761 DOI: 10.1590/1677-5449.003416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.
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Vascular Anatomy and Clinical Application of Anterolateral Leg Perforator Flaps. Plast Reconstr Surg 2013; 131:534e-543e. [DOI: 10.1097/prs.0b013e3182827675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Papadimas D, Paraskeuopoulos T, Anagnostopoulou S. Cutaneous perforators of the peroneal artery: Cadaveric study with implications in the design of the osteocutaneous free fibular flap. Clin Anat 2009; 22:826-33. [DOI: 10.1002/ca.20847] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Papadimas D, Paraskeuopoulos T, Anagnostopoulou S. A superficial branch of the peroneal artery giving rise to septocutaneous perforating branches and its clinical significance. J Plast Reconstr Aesthet Surg 2009; 62:423-4. [DOI: 10.1016/j.bjps.2008.04.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2008] [Accepted: 04/26/2008] [Indexed: 11/24/2022]
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