Lateral Supramalleolar Perforator Flap Reconstruction Through Branches Outside of the Ankle Tissue Defects

NCT ID: NCT04687345

Last Updated: 2020-12-29

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 15 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2007-01-01
• Study Completion Date: 2018-12-12

Brief Summary

The lateral ankle is a common site of tissue defects and the defects in this area are often accompanied by exposure of the fibula and tendons. Microsurgical tissue transfer or a pedicled flap is needed to cover those exposures for even a relatively small defect due to the insufficiency of the local cutaneous and muscle flap in this area. Koshima et al. and Wei et al. began to propose the concept of localized perforator flaps, which were initially applied to free perforator flaps. The main benefits of such localized perforator flaps are described below.

1. It preserves vital blood vessels and the underlying muscles and fascia.

2. Complications in the donor area are rare and can be direct or partial sutures.

3. Not technically demanding, although we need to find the vessel but not the vessel junction.

4. Shorter surgery time.

There are many choices of perforator flaps for lateral ankle soft tissue defects, including lateral upper ankle flap, retrograde anterior tibial artery flap, retrograde gastrocnemius flap, etc. Among them, the lateral upper ankle flap is one of the flaps commonly used for reconstruction of lateral ankle tissue defects, and the research on the lateral upper peroneal artery perforator flap is limited.

Detailed Description

The purpose of this study is to evaluate the clinical application of the peroneal artery perforator flap with or without split-thickness skin grafting for soft tissue reconstruction of the bony defect of the lateral malleolus of the ankle joints. Reconstruction using a peroneal artery perforator flap with or without split-thickness skin grafting was performed for 10 men and 5 women patients with defects in the lateral malleolus. The mean age was 53.7 years with the age range between 22 and 89 years, and the mean size of the flaps was 40 cm^2. The soft tissue defects were caused by a diabetic foot (6 patients), infected bursitis (1 patient), chronic osteomyelitis (2 patients), and trauma (6 patients). Three of six diabetes mellitus patients also had peripheral arterial occlusive disease. The flaps were elevated in the form of a perforator flap, and split-thickness skin grafting was performed over the flaps and adjoining raw areas. The pedicled supramalleolar perforator flap is classified into two categories: (A) propeller and (B) rotation flaps. The mean follow-up duration was 30 months postsurgical.

Conditions

Ankle Tissue Injury Wound

Study Design

• Observational Model Type: CASE_ONLY
• Study Time Perspective: RETROSPECTIVE

Study Groups

Propeller Flap

The propeller flap is based on a perforator that serves as a pivot joint, allowing the flap to rotate up to 180°. It provides the advantages of greater freedom of movement and versatility in flap design.

No interventions assigned to this group

Rotation Flap

The rotation flap is primarily supplied by the perforator artery accompanied by the random supply from the skin base. It is also associated with a lower venous congestion risk.

No interventions assigned to this group

Eligibility Criteria

Inclusion Criteria

• The subject is aged 20 years old or above (including 20 years old), regardless of gender.
• Patients with lateral ankle tissue defects

Exclusion Criteria

• The subject is aged under 20 years old.
• Patients with tissue metabolic disorders, immune dysfunction, and drug abuse.
• Patients with severe primary diseases or mental illness such as those involving the hematopoietic system, endocrine system, etc.
• Pregnant and lactating women.
• Patient who is unwilling or unable to cooperate with the trial process or follow medical advice.

• Minimum Eligible Age: 20 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Defense Medical Center, Taiwan

OTHER

Sponsor Role: lead

Responsible Party

Shih Yu-Jen

Lecturer/Attending Doctor

Responsibility Role: PRINCIPAL_INVESTIGATOR

References

Hallock GG. Distal lower leg local random fasciocutaneous flaps. Plast Reconstr Surg. 1990 Aug;86(2):304-11. doi: 10.1097/00006534-199008000-00018.

Reference Type: BACKGROUND

PMID: 2367579 (View on PubMed)

Koshima I, Itoh S, Nanba Y, Tsutsui T, Takahashi Y. Medial and lateral malleolar perforator flaps for repair of defects around the ankle. Ann Plast Surg. 2003 Dec;51(6):579-83. doi: 10.1097/01.sap.0000095654.07024.65.

Reference Type: BACKGROUND

PMID: 14646653 (View on PubMed)

Wei FC, Seah CS, Tsai YC, Liu SJ, Tsai MS. Fibula osteoseptocutaneous flap for reconstruction of composite mandibular defects. Plast Reconstr Surg. 1994 Feb;93(2):294-304; discussion 305-6.

Reference Type: BACKGROUND

PMID: 8310021 (View on PubMed)

Other Identifiers

PerforatorFlap2018

Identifier Type: -

Identifier Source: org_study_id