Posterior tibial artery perforator flap. Case series.
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Published:
Aug 5, 2019
Keywords:
Posterior tibial artery perforator, flap, coverage defects
Main Article Content
Abstract
Introduction: Coverage defects in the leg are a challenge due to the particulars of the anatomy in said area, different reconstruction strategies have been developed, being the fasciocutaneous perforator flaps the most frequently used. The aim of this paper is to discuss the therapeutic alternative and to describe the surgical technique, the results and the complications of the posterior tibial artery perforator flap (PTAPF) to treat coverage defects.Materials and Methods: We performed a retrospective review of patients treated with a fasciocutaneous flap. We analyzed preoperative demographic variables. The surgical technique and the indications in each patient are described. Finally, the postoperative variables, such as complications and flap survival, were analyzed.Results: Twelve patients (all male) treated with PTAPF were included. The average age at the time of surgery was 52 years (range: 29-77 years). The maximum follow-up was 55 months, with a minimum of 5 months (average: 18 months). There were two flaps with transient congestion that reverted spontaneously: one partial failure and one total failure.Conclusions: PTAPF should be considered a viable option for the treatment of small- and medium-sized leg wounds, since they provide similar tissue thickness, texture and color on the recipient site, achieving good clinical and cosmetic results.
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How to Cite
De Cicco, F. L., Taype Zamboni, D., Barla, J. D., Sancineto, C. F., & Carabelli, G. (2019). Posterior tibial artery perforator flap. Case series. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(3), 242-251. https://doi.org/10.15417/issn.1852-7434.2019.84.3.935
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Clinical Research
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References
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https://doi.org/ 10.1016/j.injury.2014.10.037
2. Mendieta M, Cabrera R, Siu A, Altamirano R, Gutierrez S. Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects. Plast Reconstr Surg Glob Open 2018;6(5):e1759. https://doi.org/ 10.1097/GOX.0000000000001759
3. Yasir M, Wani AH, Zargar HR. Perforator flaps for reconstruction of lower limb defects. World J Plast Surg 2017;6(1):74-81. PMID: 28289617
4. Özalp B, Aydınol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg 2016;69(10):e205-11. https://doi.org/ 10.1016/j.bjps.2016.07.015
5. Schaverien MV, Hamilton SA, Fairburn N, Rao P, Quaba AA. Lower limb reconstruction using the islanded posterior tibial artery perforator flap. Plast Reconstr Surg 2010;125(6):1735-43. https://doi.org/ 10.1097/PRS.0b013e3181ccdc08
6. Hamdi MF, Kalti O, Khelifi A. Experience with the distally based sural flap: a review of 25 cases. J Foot Ankle Surg 2012;51(5):627-31. https://doi.org/10.1053/j.jfas.2012.05.029
7. Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, Germann GK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg 2003;112(1):129-40; discussion 141-2. https://doi.org/10.1097/01.PRS.0000066167.68966.66
8. Carabelli G, Barla JD, Taype DR, Sancineto CF. Colgajo fasciocutáneo sural para la cobertura del tercio distal de pierna y pie. Rev Asoc Argent Ortop Traumatol 2017;82(2):136-40. http://dx.doi.org/10.15417/602
9. Erdmann MW, Court-Brown CM, Quaba AA. A five year review of islanded distally based fasciocutaneous flaps on the lower limb. Br J Plast Surg 1997;50(6):421-7. PMID: 9326145
10. El-Sabbagh AH. Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot. Chin J Traumatol 2018;21(4):197-205. https://doi.org/10.1016/j.cjtee.2017.08.009
11. Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 2008;122(1):161-70. http://dx.doi.org/10.1097/PRS.0b013e3181774386
12. Morrison WA, Shen TY. Anterior tibial artery flap: anatomy and case report. Br J Plast Surg 1987;40(3):230-5. PMID: 3594049
13. Sur YJ, Morsy M, Mohan AT, Zhu L, Michalak GJ, Lachman N, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg 2016;137(5):1615-28. http://dx.doi.org/10.1097/PRS.0000000000002111
14. Wu WC, Chang YP, So YC, Yip SF, Lam YL. The anatomic basis and clinical applications of flaps based on the posterior tibial vessels. Br J Plast Surg 1993;46(6):470-9. PMID: 8220853
15. Pontén B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981;34(2):215-20.
PMID: 7236984
16. Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985;76(3):354-63. PMID: 3898166
17. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991;44(1):53-4.
https://doi.org/10.1016/0007-1226(91)90179-N
18. Yu D, Hou Q, Liu A, Tang H, Fang G, Zhai X, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique. Surg Radiol Anat 2016;38(9):1075-81.
http://dx.doi.org/10.1007/s00276-016-1671-4
https://doi.org/ 10.1016/j.injury.2014.10.037
2. Mendieta M, Cabrera R, Siu A, Altamirano R, Gutierrez S. Perforator propeller flaps for the coverage of middle and distal leg soft-tissue defects. Plast Reconstr Surg Glob Open 2018;6(5):e1759. https://doi.org/ 10.1097/GOX.0000000000001759
3. Yasir M, Wani AH, Zargar HR. Perforator flaps for reconstruction of lower limb defects. World J Plast Surg 2017;6(1):74-81. PMID: 28289617
4. Özalp B, Aydınol M. Perforator-based propeller flaps for leg reconstruction in pediatric patients. J Plast Reconstr Aesthet Surg 2016;69(10):e205-11. https://doi.org/ 10.1016/j.bjps.2016.07.015
5. Schaverien MV, Hamilton SA, Fairburn N, Rao P, Quaba AA. Lower limb reconstruction using the islanded posterior tibial artery perforator flap. Plast Reconstr Surg 2010;125(6):1735-43. https://doi.org/ 10.1097/PRS.0b013e3181ccdc08
6. Hamdi MF, Kalti O, Khelifi A. Experience with the distally based sural flap: a review of 25 cases. J Foot Ankle Surg 2012;51(5):627-31. https://doi.org/10.1053/j.jfas.2012.05.029
7. Baumeister SP, Spierer R, Erdmann D, Sweis R, Levin LS, Germann GK. A realistic complication analysis of 70 sural artery flaps in a multimorbid patient group. Plast Reconstr Surg 2003;112(1):129-40; discussion 141-2. https://doi.org/10.1097/01.PRS.0000066167.68966.66
8. Carabelli G, Barla JD, Taype DR, Sancineto CF. Colgajo fasciocutáneo sural para la cobertura del tercio distal de pierna y pie. Rev Asoc Argent Ortop Traumatol 2017;82(2):136-40. http://dx.doi.org/10.15417/602
9. Erdmann MW, Court-Brown CM, Quaba AA. A five year review of islanded distally based fasciocutaneous flaps on the lower limb. Br J Plast Surg 1997;50(6):421-7. PMID: 9326145
10. El-Sabbagh AH. Non-microsurgical skin flaps for reconstruction of difficult wounds in distal leg and foot. Chin J Traumatol 2018;21(4):197-205. https://doi.org/10.1016/j.cjtee.2017.08.009
11. Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 2008;122(1):161-70. http://dx.doi.org/10.1097/PRS.0b013e3181774386
12. Morrison WA, Shen TY. Anterior tibial artery flap: anatomy and case report. Br J Plast Surg 1987;40(3):230-5. PMID: 3594049
13. Sur YJ, Morsy M, Mohan AT, Zhu L, Michalak GJ, Lachman N, et al. Three-dimensional computed tomographic angiography study of the interperforator flow of the lower leg. Plast Reconstr Surg 2016;137(5):1615-28. http://dx.doi.org/10.1097/PRS.0000000000002111
14. Wu WC, Chang YP, So YC, Yip SF, Lam YL. The anatomic basis and clinical applications of flaps based on the posterior tibial vessels. Br J Plast Surg 1993;46(6):470-9. PMID: 8220853
15. Pontén B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981;34(2):215-20.
PMID: 7236984
16. Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985;76(3):354-63. PMID: 3898166
17. Hyakusoku H, Yamamoto T, Fumiiri M. The propeller flap method. Br J Plast Surg 1991;44(1):53-4.
https://doi.org/10.1016/0007-1226(91)90179-N
18. Yu D, Hou Q, Liu A, Tang H, Fang G, Zhai X, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique. Surg Radiol Anat 2016;38(9):1075-81.
http://dx.doi.org/10.1007/s00276-016-1671-4