Sahakyan A. B., Yagdjyan G. V.
YSMU, The University Hospital No. 1,
Centre of Plastic and Reconstructive Surgery & Microsurgery,
Yerevan, Armenia
The reconstruction of foot tissue defect is one of the difficult problems in plas--tic surgery. Their treatment peculiarities are conditioned by both of anato-mi-cal structure complication and specific supporting function. The island reverse flaps are widely applied in the reconstructive surgery lately. The present report is concerning to the application of vascularized island reverse flaps from the shin in treatment of 5 patients with soft-tissue foot defect.
MATERIALS AND METHODS.
In the Centre of Plastic and Reconstructive Surgery from 1996 to 1997 were treated 10 patients with soft-tissue foot defect (all of them are male, aged 18 - 28). The island flaps from shin on a distal pedicle were taken in 6 patients as vascularized flaps. In 3 patients was applied the distal sural flap (on the basis of sural nerve artery), and in 2 patients - the distal supramaleolar one. In one patient the transplantation of supramaleolar flap was become impossible owing to the absence of the distal pedicle. The soft-tissue defect of the foot was caused by wounding after mine explosion in one patient, and after extremity frost-bite injury - in the other patient; in 3 patients vascularized flaps were used to substitute the soft-tissue defects after mechanical trauma. They are admitted to the hospital after injuries in different space of time (from a few hours to 2 months). In 3 patients the defect was in the calcanean tuber region, and in 2 patients - in the medial malleolus region. There was found out the injury of anterior tibial vessel bundle in this group of 6 patients. Dermatomic plasty of donor zone was realized in 4 patients, and the primary healing of donor wound was achieved in one case.
RESULTS.
All the 5 applied flaps were grafted and provided the complete substitution of defect. The signs of expressed venous insufficiency were deter-mi-ned in one patient intraoperatively, what served as an indication for venous anas-to-mosis application between free distal end of vein (included into the composite of subcutaneous flap component) and large subcutaneous vein osti-um, getting possible an additional drainage of venous blood from the rotatory flap. The satisfactory aesthetic result of recipient zone as well as of donor zone was obtained.
DISCUSSION.
The advantages of foot plasty by means of shin island flaps are the followings: the technical simplicity of operation, the absence of ligation necessity of main shin arteries, as well as a possibility of operation performance in case of injuries of the latter. Peculiarities of anatomical flaps, based on the sural ner-ve artery (turning point of flap), allow to produce defect substitution of medial and lateral region of the heel posterior surface, as well as of distal section of heel dorsal surface. The presence of sensitive nerve in the transplant composite allows to carry out the innervation of the latter. It is an indubitable advantage of this transplant, especially in plasty of proximal sections of heel region. In spite of more complicated technical dissection of the distal supramaleolar flap (large anatomical variability of vascular angioarchitectonics) compared with the flap dissection on the sural nerve artery, this method is more simple than transplantation of complex composite flap with microanastomosis application. The length of vascular pedicle of flap allows to make substitution of dorsal sur-face of heel proximal section, of malleolus medial and lateral region, of the foot anteriolateral surface. Contradictions to island flap application are the traumas, fo-reign bodies and inflammatory processes in vascular pedicle regions of these flaps.
CONCLUSIONS.
- The presence of several additional flap types allows to choose the most sui-table transplant in dependence of localization, depth and size of foot tissue defect.
- In the relatively small defects of heel region (except plantar one) expediently is the flap plasty on the basis of the sural nerve artery with the further reinnervation, whereas for substitution of dorsal surface of heel proximal section and malleolus region it will be more reasonable to use a supramaleolar flap.