Repair of tophus wound of the heel with sural nerve nutrition flap with peroneal artery perforating branch: a retrospective study

BACKGROUND

This study was to investigate the clinical effect of a sural nerve nutrition flap with peroneal artery perforator for repairing tophus wound of the heel.

METHODS

Over a 5-year period, 7 elderly male patients with tophus ulceration of the heel were admitted with exposed Achilles' tendon, and a chronic unhealed wound. Debridement, expansion and vacuum sealing drainage (VSD) lavage were performed initially, with simultaneous uric acid-lowering treatment. A 4×6-8×10 cm sural nerve nutrition flap with peroneal artery perforator was the secondary repair after further debridement of the wound. Preoperative Doppler ultrasound located the penetrating point of the peroneal artery perforator as the rotation point of the flap, and the line between the midpoint of the Achilles' tendon and the lateral malleolus and the midpoint of the popliteal fossa 5° above the front of Achilles' tendon was the axis. The patients were treated postoperatively with anti-inflammatory, anticoagulant and spasmolytic drugs and other rehydration therapy, and allopurinol was continued to control uric acid. The blood supply and temperature of the flap and wound healing were monitored.

RESULTS

All 7 flaps survived completely after operation, with 1 case of postoperative wound discharge that finally healed after dressing change and 1 case of skin flap redness and swelling, which improved after strengthening anti-infection treatment. All 7 patients were followed up for 6-12 months (average 10 months). The skin flaps were soft in texture, with good color and appearance, and no recurrence of ulceration. The dorsal extension and plantar flexion of the ankle joint were good, and function was satisfactory.

CONCLUSIONS

The sural nerve nutrition flap with peroneal artery perforator has double blood supply, strong anti-infective ability, relatively fast tissue healing process, simple operation and high survival rate, making it ideal for repairing tophus wounds of the heel.

Lateral supramalleolar flap: Is it based on perforator of peroneal / anterior tibial artery; A cross-sectional study at tertiary care centre

Background

To determine the anatomical basis of supramalleolar flap; retrograde versus antegrade and its clinical outcome based on the vascular pattern.

Methods

This analytic cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. Patients who underwent coverage of soft tissue defects around the foot and ankle with supramalleolar flaps were included. Data collection was through medical records including demographic parameters, mechanism of injury, per-operative findings of perforator origin, and patient interviewing for final assessment. Patients with peripheral vascular disease, unavailability of skin, and radiation injuries were excluded. All analysis was done using SPSS version 25.0.

Results

49 patients were included in the study from May 1999 to December 2020. The male to female ratio was 37:12. The cause of soft tissue defects was trauma in 9 (38.7%) followed by Infection in 16 (32.6%) and Blast injury in 5 cases (10.2%). The maximum flap size harvested was 20 × 8 cm. In 19 cases the peroneal artery perforator was absent and the flap was based on the perforator of an anterolateral malleolar branch (antegrade) while the remaining 30 flaps were based on the perforator of the peroneal artery (retrograde). Overall, the flap survival rate was 98%; as 1 case had partial necrosis and required skin grafting. However, there were 9 minor complications. In 8 patients, the flap was rotated as a 'delay flap' . All patients had satisfactory functional outcomes without significant morbidity of the donor site.

Conclusion

The lateral supramalleolar flap provided coverage to almost all regions of the foot and ankle with a cosmetically acceptable donor and recipient site. There were no problems with shoe wear, as only 2 patients required defatting for cosmetic reasons. Microvascular expertise was required for a predictable outcome.