Lower Extremity Reconstruction of Soft Tissue Defects with Perforator Island Flap

하지의 연부조직 결손에 있어 천공지 도서형 피판술을 이용한 재건

  • Lee, Tae Hoon (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Choi, Jae Won (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Lee, Jun Ho (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University) ;
  • Kim, Hyo Heon (Department of Plastic & Reconstructive Surgery, College of Medicine, Yeungnam University)
  • 이태훈 (영남대학교 의과대학 성형외과학교실) ;
  • 최재원 (영남대학교 의과대학 성형외과학교실) ;
  • 이준호 (영남대학교 의과대학 성형외과학교실) ;
  • 김효헌 (영남대학교 의과대학 성형외과학교실)
  • Received : 2005.04.01
  • Published : 2005.07.10

Abstract

The reconstruction of deep soft tissue defects of lower extremities combined with bone exposure has been difficult problems. When it is impossible to raise local skin flap, we have been usually used the gastrocnemius musculocutaneous flap, cross leg flap or free flaps. However, In musculocutaneous flap, aesthetical appearance of the calf is not appropriate because of too bulky flap. Although the success rate of the free flap has improved, still failure of flap occurs in cases of the chronic ischemic state. As the concepts of perforator flap has recently developed and widely used due to its thin flap thickness. Between January 2002 to December 2004, we treated 7 patients with soft tissue defect in leg with chronic ischemic limbs with perforator island flap. Preoperative angiography were done in all case and we used 2 medial sural perforator flaps, 1 anterior tibial artery perforator flap, 1 posterior tibial artery perforator flap, 3 anterolateral thigh perforator flap. Partial necrosis of flap was seen in one patient but no further surgical procedure was required for wound healed spontaneously. Perforator island flaps are thin, reduce donor site morbidity, conceal donor site with primary closure and it is useful for resurfacing soft tissue defect of lower extremities.

Keywords

References

  1. Choi EJ, Cha JH, Park MC: Reconstruction of the soft tissue defects in the lower extremities. J Korean Soc Plast Reconstr Surg 20: 1080, 1993
  2. Yildirim S, Gidereroglu K, Akoz T: The simple and effective choice for treatment of chronic calcaneal osteomyelitis: neurocutaneous flaps. Plast Reconstr Surg 111: 753, 2003 https://doi.org/10.1097/01.PRS.0000056833.17907.01
  3. Arnold PG, Yugueros P, Hanssen AD: Muscle flaps in osteomyelitis of the lower extremity: a 20-year account. Plast Reconstr Surg 104: 107, 1999 https://doi.org/10.1097/00006534-199907000-00015
  4. Park RH, Jang HJ, Hong IP, Kim JH: Tibialis anterior muscle flap in the repair of skin defects over the exposed tibia and implant. J Korean Soc Plast Reconstr Surg 24: 790, 1997
  5. Ponten B: The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 34: 215, 1981 https://doi.org/10.1016/S0007-1226(81)80097-5
  6. Carriquiry C, Costa MA, Vasconez LO: An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 76: 354, 1985 https://doi.org/10.1097/00006534-198509000-00003
  7. Tolhurst DE, Haeseker B, Zeeman RJ: The development of the fasciocutaneous flap and its clinical applications. Plast Reconstr Surg 71: 597, 1983 https://doi.org/10.1097/00006534-198305000-00001
  8. Healy C, Tieman E, Lamberty BGH, Campbell RC: Rotation fasciocutaneous flap repair of lower limb defects. Plast Reconstr Surg 95: 243, 1995 https://doi.org/10.1097/00006534-199502000-00003
  9. Venkataramakrishnan V, Mohan D, Villafane O: Perforator based V-Y advancement flaps in the leg. Br J Plast Surg 51: 431, 1998 https://doi.org/10.1054/bjps.1997.0229
  10. Koshima I, Soeda S: Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 42: 645, 1989 https://doi.org/10.1016/0007-1226(89)90075-1
  11. Hwang GS, Won MY, Cho EJ, Tark KC, Park BY: Sacral pressure sore treatment with gluteal perforator-based flap. J Korean Soc Plast Reconstr Surg 25: 673, 1998
  12. Hallock GG: The medial sural medial gastrocnemius perforator local flap. Ann Plast Surg 53: 501, 2004 https://doi.org/10.1097/01.sap.0000116338.59679.12
  13. Li Z, Liu K, Lin Y, Li L: Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee. Br J Plast Surg 43: 546, 1990 https://doi.org/10.1016/0007-1226(90)90118-J