Interperforator Flow Pattern and Clinical Application of Distal Extended Peroneal Artery Perforator Flaps

Abstract

IntroductionPeroneal artery perforator flaps are the most widely used pedicled flaps for soft tissue defects of the distal lower extremity. Most research regarding peroneal artery flaps focuses on the location, diameter, and number of peroneal artery perforators. However, there is little literature regarding interperforator flow patterns within the peroneal artery perforator flaps. The aims of the present study were to describe interperforator flow patterns of the distally based extended peroneal artery perforator flaps through digital subtraction angiography and review their clinical application.MethodsTwelve consecutive patients underwent digital subtraction angiography of the lower-limb arteries. The number and classification of peroneal artery perforators and the interperforator flow patterns were observed. Based on these observations, distally based extended peroneal artery perforator flaps were designed to repair nonhealing wounds located on the ankles and feet of 14 patients.ResultsThe peroneal artery gives out grades I to IV perforators in the lateral leg. There were 2 to 7 grade I perforators and true anastomoses between adjacent grade II perforators, which generate directly linked vessels in the middle leg. The grade III or IV perforators form a reticular vascular network through a large number of chock and potential anastomoses. All flaps survived and had excellent appearance and texture.ConclusionsDistally based extended peroneal artery perforator flaps appear reliable for repairing wounds located on or around the ankle and front foot. However, whether the middle perforator or peroneal artery should be used depends on the condition of the anastomosis between direct linking vessels and the distal perforator.

Clinical study on orthopaedic treatment of chronic osteomyelitis with soft tissue defect in adults

“…Multiple flap transfer technique in plastic surgery plays an important role in complex wounds of lower limbs. At present, the flaps used to repair soft tissue defects of the leg and foot include plantar medial flaps, 32 sural nerve nutrition flaps, 33 peroneal artery perforator flaps, 34 posterior tibial artery perforator flaps, 35 and so on. Masquelet confirmed the possibility of removing the sural nerve axial vascular island flap through latex perfusion, proposed the concept of axial skin flap with cutaneous nerve accompanied by blood vessels, namely “neurotrophic flap,” and applied the reverse sural nerve nutritional vessel island flap in clinical practice and achieved success 36 .…”

When free flaps are not the first choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery?

“…Other than in the proximal knee region and the upper and middle third of the lower leg, where a variety of proximally based local pedicled flaps are available, the lower third and foot and ankle region demand either free flaps or reversed pedicled flaps [11,61,62] . Various modifications of the sural and peroneusbrevis flaps have been described to optimize the outcome and minimize complications [63][64][65][66][67] . The distally based peroneus brevis flap has been described as an efficient tool for the reconstruction of the distal lower leg, ankle, Achilles tendon and proximal foot region [4,65,[68][69][70][71][72][73] .…”

Value of the combination of a smartphone-compatible infrared camera and a hand-held doppler ultrasound in preoperative localization of perforators in flaps

“…Currently, various approaches are applied in the preoperative localization and selection of perforator arteries [ 6 ], such as digital subtraction angiography [ 7 ], computed tomography angiography, and magnetic resonance angiography [ 8 ]. However, because of their disadvantages, such as their high cost, invasiveness, and requirement of large devices, these methods might not be the first choice when performing regular examinations for perforator detection.…”