Objective To assess clinical efficacy of perforators positioning technique in perforator pedicled propeller flap of the leg reconstructing soft tissue defects of distal termination of leg and around the foot and ankle. Methods Forty-six patients with soft-tissue defects in distal termination of leg and around the foot and ankle (33 males and 13 females, aged from 27 to 68 years with an average of 48.2 ) were collected to our hospital from January of 2013 to August of 2017 and were analyzed retrospectively. The defect areas was 21 cm×8 cm~8.5 cm×5.5 cm. All the patients underwent secondary repair and the repair time was 5 days~42 days after injury. Preoperative perforator positioning of the flap through the method of color doppler ultrasound(CDS) was performed. Thirty-one cases of posterior tibial artery perforators and 15 cases of radial artery perforators were included. Preoperative color doppler ultrasound was used to locate the perforator branch, and the skin flap was designed according to the perforator branch and the wound surface. The accuracy of perforator branch positioning was verified during the operation. Postoperative survival rate, complications and seven indicators of skin flap were evaluated. Results The coincidence rate was 89.1% during the operation. One case had complete necrosis after flap operation and 4 cases of anterolateral thigh perforator flaps distal partial necrosed. Thirty-four patients were sutured directly through donor incision. Twelve donor sites were skin grafted, 2 patients had partial necrosis of skin grafts, and the other donor sites healed well. In this group, one patient did not heal the infected wound around the skin flap after surgery, and two patients had a small part of skin graft necrosis in the donor site. Forty-three patients were followed up ranged 5 to 46 months (average of 14.3 months). According to the evaluation 7 indicators of skin flap function, 14 cases were excellent, 23 cases were good , 3 cases were fair, and 3 cases were poor , with an excellent and good rate of 86.0%. Conclusions The preoperative color Doppler ultrasound localized perforator pedicled propeller flaps have good effect on repairing the wound of the distal leg and around the foot and ankle, with satisfactory appearance and high clinical practicality.
Key words
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Perforator flap； Propeller； Doppler； Microsurgery
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