Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Tao ¹ ,  ZHANG Yuxuan ² , XU Yajun ² , ZHOU Jiandong ² , XU Tonglong ² , ZHANG Xingfei ² , HU Yuxuan ²

1. Department of Hand Surgery, Yixing People’s Hospital, Yixing Jiangsu, 214200, P. R. China;
2. Department of Foot and Ankle Surgery, Wuxi No.9 People’s Hospital, Wuxi Jiangsu, 214000, P. R. China;

Corresponding author：

ZHANG Yuxuan, Email: hao0821@126.com

Keywords：

Medial sural artery perforator flap; wide band linear matrix array volume transducer probe; three-dimensinal ultrasound technique; dorsum of foot; wound repair

DOI：

10.7507/1002-1892.202312079

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the accuracy of positioning perforator of medial sural artery with three-dimensional ultrasound technique guided by a wide band linear matrix array volume transducer probe before operation, and the effectiveness of the flap design based on this in repairing the dorsal foot wounds. Methods Between January 2019 and December 2022, 30 patients with skin and soft tissue defects of the dorsal foot were treated. There were 19 males and 11 females, with an average age of 43.9 years (range, 22-63 years). There were 12 cases of traffic accident injury, 15 cases of heavy crushing injury, and 3 cases of machine injury. The time from injury to hospitalization was 1-8 hours (mean, 3.5 hours). The wounds in size of 5 cm×3 cm to 17 cm×5 cm were thorough debrided and covered with vacuum sealing drainage dressing. Then the wounds were repaired with the medial sural artery perforator flaps after no obvious infection observed. To obtain the complete three-dimensional image, the number and position of the medial sural artery perforator branches and the position of the main blood vessels in the muscle were detected and recorded by wide band linear matrix array volume transducer probe before operation. Suitable perforating branches were selected to design the flap and guide the flap incision on this basis. The size of the perforating flap ranged from 6 cm×4 cm to 18 cm×6 cm. The sensitivity and positive predictive value were calculated by comparing preoperative exploration with intraoperative observation of perforating branches, so as to evaluate the positioning accuracy of three-dimensional ultrasound technique. The donor sites were sutured directly in 25 cases and repaired with free skin grafting in 5 cases. Results The 60 perforating branches of medial sural artery were found before operation and 58 during operation in 30 patients. Among them, pre- and intra-operative perforations were consistent with 56. The sensitivity was 93.3% and positive predictive value was 96.6%. The intramuscular position and route of the main blood vessels were basically consistent with the pre- and intra-operative observation. All flaps survived and wounds healed by first intention. All incisions at the donor sites healed by first intention, and all skin grafts survived. All patients were follow up 9-24 months (mean, 14.7 months). The appearance, color, and texture of the flaps were good, and no obvious effect on wearing shoes and walking. At last follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind score ranged from 80 to 92, with an average of 87.5. The patient satisfaction was excellent in 29 cases and good in 1 case. Conclusion The three-dimensional ultrasound technique guided by the wide band linear matrix array volume transducer probe can accurately locate the perforating branch of the medial sural artery, and the three-dimensional imaging is more intuitive, which can be used to guide the design and incision of the medial sural artery perforator flap.

Citation： MA Tao, ZHANG Yuxuan, XU Yajun, ZHOU Jiandong, XU Tonglong, ZHANG Xingfei, HU Yuxuan. Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 593-597. doi: 10.7507/1002-1892.202312079 Copy

1.	冉小叶, 刘元波, 杨若梦, 等. 穿支螺旋桨皮瓣连续转移技术在下肢远端软组织缺损修复中的临床应用. 中国修复重建外科杂志, 2022, 36(4): 451-455.
2.	彭平, 董忠根, 魏建伟, 等. 逆行带蒂腓肠筋膜皮瓣的部分坏死相关因素分析. 中国矫形外科杂志, 2022, 30(8): 673-677.
3.	陈玉兵, 王丽丽. 足背动脉穿支蒂皮瓣修复前足背侧皮肤软组织缺损疗效观察. 中国修复重建外科杂志, 2017, 31(5): 632-634.
4.	Mehmood Hashmi P, Musaddiq A, Hashmi A, et al. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Ann Med Surg (Lond), 2021, 73: 103109. doi: 10.1016/j.amsu.2021.103109.
5.	舒景坤, 李红, 赵连伟. 旋转点下移的外踝上皮瓣修复足内侧皮肤软组织缺损. 实用手外科杂志, 2021, 35(4): 497-499.
6.	范爱民, 陈燕, 李政, 等. 游离股前外侧穿支皮瓣修复足踝部软组织缺损. 中国矫形外科杂志, 2022, 30(10): 937-939.
7.	徐宝成, 蒙显晨, 汪金根, 等. 游离腓肠内侧动脉穿支皮瓣修复四肢软组织缺损. 中华手外科杂志, 2022, 38(3): 233-235.
8.	方杰, 陈步国, 吴尧, 等. 腓肠内侧动脉穿支皮瓣临床应用研究进展. 中国修复重建外科杂志, 2021, 35(4): 508-513.
9.	Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
10.	杨涛, 赵磊, 宋科, 等. 游离腓肠内侧动脉穿支皮瓣对足趾皮肤缺损的美学修复. 中华整形外科杂志, 2022, 38(2): 176-179.
11.	Al-Himdani S, Din A, Wright TC, et al. The medial sural artery perforator (MSAP) flap: A versatile flap for lower extremity reconstruction. Injury, 2020, 51(4): 1077-1085.
12.	Steel BJ, Mehta D, Nugent M, et al. Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps. Oral Maxillofac Surg, 2023, 27(4): 655-659.
13.	王珏, 刘海峰, 王旭东, 等. 彩色多普勒超声和CT血管造影技术在下肢穿支皮瓣临床应用中的对比研究. 组织工程与重建外科, 2021, 17(5): 400-404.
14.	Moore R, Mullner D, Nichols G, et al. Color Doppler ultrasound versus computed tomography angiography for preoperative anterolateral thigh flap perforator imaging: a systematic review and meta-analysis. J Reconstr Microsurg, 2022, 38(7): 563-570.
15.	方军, 赵光宗, 李华壮, 等. 三维CT血管造影辅助游离腓肠内侧动脉穿支皮瓣修复足部创面的疗效. 中华烧伤与创面修复杂志, 2023, 39(4): 343-349.
16.	Abdelrahman M, Jumabhoy I, Qiu SS, et al. Perfusion dynamics of the medial sural artery perforator (MSAP) flap in lower extremity reconstruction using laser Doppler perfusion imaging (LDPI): a clinical study. J Plast Surg Hand Surg, 2020, 54(2): 112-119.
17.	Hallock GG. The medial sural artery perforator flap: a historical trek from ignominious to “Workhorse”. Arch Plast Surg, 2022, 49(2): 240-252.

1. 冉小叶, 刘元波, 杨若梦, 等. 穿支螺旋桨皮瓣连续转移技术在下肢远端软组织缺损修复中的临床应用. 中国修复重建外科杂志, 2022, 36(4): 451-455.
2. 彭平, 董忠根, 魏建伟, 等. 逆行带蒂腓肠筋膜皮瓣的部分坏死相关因素分析. 中国矫形外科杂志, 2022, 30(8): 673-677.
3. 陈玉兵, 王丽丽. 足背动脉穿支蒂皮瓣修复前足背侧皮肤软组织缺损疗效观察. 中国修复重建外科杂志, 2017, 31(5): 632-634.
4. Mehmood Hashmi P, Musaddiq A, Hashmi A, et al. Comparison of distally based sural artery and supramalleolar flap for coverage of dorsum of foot and ankle defects; a cross-sectional study of 53 patients. Ann Med Surg (Lond), 2021, 73: 103109. doi: 10.1016/j.amsu.2021.103109.
5. 舒景坤, 李红, 赵连伟. 旋转点下移的外踝上皮瓣修复足内侧皮肤软组织缺损. 实用手外科杂志, 2021, 35(4): 497-499.
6. 范爱民, 陈燕, 李政, 等. 游离股前外侧穿支皮瓣修复足踝部软组织缺损. 中国矫形外科杂志, 2022, 30(10): 937-939.
7. 徐宝成, 蒙显晨, 汪金根, 等. 游离腓肠内侧动脉穿支皮瓣修复四肢软组织缺损. 中华手外科杂志, 2022, 38(3): 233-235.
8. 方杰, 陈步国, 吴尧, 等. 腓肠内侧动脉穿支皮瓣临床应用研究进展. 中国修复重建外科杂志, 2021, 35(4): 508-513.
9. Lin CH, Hsieh YH, Lin CH. The medial sural artery perforator flap in lower extremity reconstruction. Clin Plast Surg, 2021, 48(2): 249-257.
10. 杨涛, 赵磊, 宋科, 等. 游离腓肠内侧动脉穿支皮瓣对足趾皮肤缺损的美学修复. 中华整形外科杂志, 2022, 38(2): 176-179.
11. Al-Himdani S, Din A, Wright TC, et al. The medial sural artery perforator (MSAP) flap: A versatile flap for lower extremity reconstruction. Injury, 2020, 51(4): 1077-1085.
12. Steel BJ, Mehta D, Nugent M, et al. Utility of preoperative colour flow Doppler assessment of perforator anatomy in medial sural artery perforator (MSAP) free flaps. Oral Maxillofac Surg, 2023, 27(4): 655-659.
13. 王珏, 刘海峰, 王旭东, 等. 彩色多普勒超声和CT血管造影技术在下肢穿支皮瓣临床应用中的对比研究. 组织工程与重建外科, 2021, 17(5): 400-404.
14. Moore R, Mullner D, Nichols G, et al. Color Doppler ultrasound versus computed tomography angiography for preoperative anterolateral thigh flap perforator imaging: a systematic review and meta-analysis. J Reconstr Microsurg, 2022, 38(7): 563-570.
15. 方军, 赵光宗, 李华壮, 等. 三维CT血管造影辅助游离腓肠内侧动脉穿支皮瓣修复足部创面的疗效. 中华烧伤与创面修复杂志, 2023, 39(4): 343-349.
16. Abdelrahman M, Jumabhoy I, Qiu SS, et al. Perfusion dynamics of the medial sural artery perforator (MSAP) flap in lower extremity reconstruction using laser Doppler perfusion imaging (LDPI): a clinical study. J Plast Surg Hand Surg, 2020, 54(2): 112-119.
17. Hallock GG. The medial sural artery perforator flap: a historical trek from ignominious to “Workhorse”. Arch Plast Surg, 2022, 49(2): 240-252.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional ultrasound technique in repairing dorsal foot wounds with medial sural artery perforator flaps

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content