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CC BY-NC-ND 4.0 · Indian J Plast Surg 2021; 54(03): 272-277
DOI: 10.1055/s-0041-1734568
Original Article

Radiological Evaluation of Postsurgical Course of Perforators in Retrograde Posterior Tibial Fasciocutaneous Flaps for Distal Leg and Foot Defects

Neeraj Kant Agrawal 
1   Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Visweswar Bhattacharya
1   Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
,
Rahul Dubepuria
2   Department of General Surgery, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Abstract

Background Mapping of vascular perforators by various methodologies have been described for planning of a variety of flaps in the lower limbs. We attempted to assess the changes in posterior tibial perforators after transfer of fasciocutaneous flaps for leg defects.

Methods 20 patients with distal leg and foot defects were studied by computed tomography angiography (CTA) and preoperative audio Doppler to ascertain perforators of posterior tibial artery. Fasciocutaneous flaps were raised, based on these perforators, depending on the site and size of soft-tissue defects. The number of perforators and their distance from the medial malleolus were also studied. Postoperative CTA was performed on the 7th to 10th day, with emphasis on postoperative changes of the perforators on which the flaps were based.

Results One to four posterior tibial perforators were found between 5 cm and 8 cm proximal to the medial malleolus. After flap transfer, the perforators could be traced to variable distance through the total length of the flap. The perforators formed small vascular loop in 12 patients, following retrograde posterior tibial flap transfer. The height of the loop, the number of such loops, the dilatation and tortuosity of the perforators, and their longitudinal orientation were studied in detail. Most of the findings can be explained by mechanical realignment of perforators as well as by the delay phenomenon associated with retrograde fasciocutaneous flaps.

Conclusion It was concluded that the morphological changes associated with the perforators explained the vascular rationality and success of these flaps.

Keywords

posterior tibial perforators - fasciocutaneous flaps - pedicled flaps - perforator assessment - CTA - vascular mapping


Publication History

Article published online:
02 September 2021

© 2021. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Cormack GC, Lamberty BG. A classification of fascio-cutaneous flaps according to their patterns of vascularisation. Br J Plast Surg 1984; 37 (01) 80-87
    CrossrefPubMedGoogle Scholar
  • 2 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 (01) 161-170
    CrossrefPubMedGoogle Scholar
  • 3 Drimouras G, Kostopoulos E, Agiannidis C. et al Redefining vascular anatomy of posterior tibial artery perforators: a cadaveric study and review of the literature. Ann Plast Surg 2016; 76 (06) 705-712
    CrossrefPubMedGoogle Scholar
  • 4 Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg: anatomical basis and clinical applications. Plast Reconstr Surg 2005; 115 (03) 793-801
    CrossrefPubMedGoogle Scholar
  • 5 Tan BK, Ng RT, Tay NS, Tan BS. Tissue microangiography using a simplified barium sulphate cadaver injection technique. Ann Acad Med Singapore 1999; 28 (01) 152-154
    PubMedGoogle Scholar
  • 6 Rees MJ, Taylor GI. A simplified lead oxide cadaver injection technique. Plast Reconstr Surg 1986; 77 (01) 141-145
    CrossrefPubMedGoogle Scholar
  • 7 Ribuffo D, Atzeni M, Saba L. et al Clinical study of peroneal artery perforators with computed tomographic angiography: implications for fibular flap harvest. Surg Radiol Anat 2010; 32 (04) 329-334
    CrossrefPubMedGoogle Scholar
  • 8 Shejbal D, Drvis P, Bedekovic V. Thermography-measured effect of capsaicin, methylprednisolone and mitomycin on the survival of random skin flaps in rats. Skin Res Technol 2012; 18 (02) 157-161
    CrossrefPubMedGoogle Scholar
  • 9 Gravvanis A, Petrocheilou G, Tsoutsos D, Delikonstantinou I, Karakitsos D. Integrating imaging techniques in lower limb microsurgical reconstruction: focusing on ultrasonography versus computed tomography angiography. In Vivo 2013; 27 (03) 371-375
    PubMedGoogle Scholar
  • 10 Blondeel PN, Van Landuyt KH, Monstrey SJ. et al The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112 (05) 1378-1383 quiz 1383, 1516, discussion 1384–1387
    CrossrefPubMedGoogle Scholar
  • 11 Dhar SC, Taylor GI. The delay phenomenon: the story unfolds. Plast Reconstr Surg 1999; 104 (07) 2079-2091
    CrossrefPubMedGoogle Scholar
  • 12 Bhattacharya V, Agrawal NK, Chaudhary GR, Arvind S, Bhattacharya S. CT angiographic evaluation of perforators in the lower limb and their reconstructive implication. Indian J Plast Surg 2012; 45 (03) 494-497
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Tsur H, Daniller A, Strauch B. Neovascularization of skin flaps: route and timing. Plast Reconstr Surg 1980; 66 (01) 85-90
    CrossrefPubMedGoogle Scholar
  • 14 Zhuang Y, Hu S, Wu D, Tang M, Xu DC. A novel in vivo technique for observations of choke vessels in a rat skin flap model. Plast Reconstr Surg 2012; 130 (02) 308-317
    CrossrefPubMedGoogle Scholar
  • 15 Carriquiry C, Aparecida Costa M, Vasconez LO. An anatomic study of the septocutaneous vessels of the leg. Plast Reconstr Surg 1985; 76 (03) 354-363
    CrossrefPubMedGoogle Scholar
  • 16 Bulla A, De L Luca, Campus GV, Rubino C, Montella A, Casoli V. The localization of the distal perforators of posterior tibial artery: a cadaveric study for the correct planning of medial adipofascial flaps. Surg Radiol Anat 2015; 37 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 17 Haertsch PA. The blood supply to the skin of the leg: a post-mortem investigation. Br J Plast Surg 1981; 34 (04) 470-477
    CrossrefPubMedGoogle Scholar
  • 18 Bhattacharya V, Goyal S, Bashir SA. Reconstructive implications of adipofascial flaps in limb defects. Eur J Plast Surg 2007; 30: 169-175
    CrossrefGoogle Scholar
  • 19 Agrawal NK, Gupta M. Distally based non-axial fascial hinged flaps: useful adjunct to resurface traumatic soft tissue defects of the distal leg. Int J Contemp Med Res 2020; 7 (06) 1-6
    Google Scholar
  • 20 Yang X, Chen G, Zeng H, Wang W, Chen Y, Li Z. Distal posterior tibial artery perforator flaps for the treatment of chronic lower extremity wounds. Int J Clin Exp Med 2016; 9 (10) 19553-19560
    Google Scholar