Abstract:

Objective

To observe the application efficacy of pedicle perforator flap in the repair of deep tissue exposed wounds such as tendons or bones in the hands， feet， and ankles.

Methods

From May 2020 to April 2023， 47 cases of deep exposed wounds such as tendons or bones in the hands， feet， and ankles who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the 910th Hospital of Joint Service Support Unit of PLA， including 29 males and 18 females， aged 25-68 years.There were 20 cases of hand wounds （3 cases each had 2 wounds with exposed tendons in the hand） and 27 cases of foot and ankle wounds.The wound area after debridement ranged from 1.0 cm×2.0 cm to 12.0 cm×6.0 cm.The pedicle perforator flaps were used for repair， of which proper digital artery perforator flaps were used in 12 cases， metacarpophal dorsal artery perforator flaps were used in 8 cases， peroneal artery perforator flaps were used in 12 cases， posterior tibial artery perforator flaps were used in 12 cases， and the first plantar metatarsal artery perforator flaps were used in 3 cases.The flap incision area ranged from 1.2 cm×2.5 cm to 13.0 cm×6.5 cm.The donor sites of flaps were repaired with sutures or skin grafting.The survival of flaps and wound healing of the donor sites were observed after surgery.During follow-up， the appearance of the flap and the wound recovery of the donor sites were observed， and complications such as bone nonunion and osteomyelitis were observed in the patients with fractures，observed the scar condition of the surgical area.At the last follow-up， the hand function of the patients were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association，and the foot function of the patients were evaluated according to the scoring standards of American Orthopedic Foot and Ankle Society （AOFAS）.

Results

A total of 50 pedicle perforator flaps were used in 47 patients，of which 45 flaps survived completely， 2 proper digital artery perforator flaps and 1 posterior tibial artery perforator flap with poor returnand and superficial tissue necrosis occurred at distal end of flap were healed by dressing change in the later stage， and 1 posterior tibial artery perforator flap and 1 the first plantar metatarsal artery perforator flap were partially necrotic and repaired by adjacent flap metastasis again.Eighteen donor sites were directly sutured， and 32 donor sites were repaired by skin grafting， all the donor sites were healed in one stage.After 6-18 months of follow-up， the appearance of the flaps were good， the texture and color of the flap were similar to those of the surrounding skin，and was not obviously bloated in appearance， only 2 peroneal artery perforator flaps and 2 posterior tibial artery perforator flaps were readmitted to the hospital for flap thinning surgery， and the scar hyperplasia in the donor sites was not obvious.There were 14 cases with excellent hand function and 6 cases with good hand function， the foot and ankle function of the affected limb was evaluated as excellent in 21 cases， good in 6 cases， and no complications such as nonunion or osteomyelitis occurred in patients with fractures.

Conclusion

The pedicle perforator flap using in the repair of deep tissue exposed wounds in the hands， feet and ankles has the advantages of flexible design， high utilization rate of flap tissue， the texture is similar to that of the affected area， and the same field of view in the surgical area， and the appearance and function recover well.

Key words: Perforator flap, Surgical flap, Wound repair, Wound healing, Trauma and injury