Free thoracoumbilicus flap for repairing severe skin and soft tissue defect of foot and ankle

HU Rui; REN Yi-jun; YAN Li; YI Xin-cheng; HUANG Zhen-feng; HAN Qiong

doi:10.3969/j.issn.1009-4237.2017.11.002

Abstract：Objective To investigate the clinical effect of free thoracoumbilicus flap for repairing severe skin and soft tissue defect at foot and ankle .Methods From Jan.2009 to Jan.2015,25 patients suffering from large-area skin and soft tissue defect wound at foot and ankle were treated with transplantation of the free thoracoum -bilicus flap.There were 13 males and 12 females,with an average age of 38.3 years (range,19-64 years).Of all the patients ,4 cases had defect wound at inner foot and malleolus ,10 at dorsum of foot and ankle ,6 at external foot and malleolus,and 5 at inner foot and planta .The wound defect area ranged from 16cm ×12cm to 36cm ×14cm.All the patients accepted transplantation of free thoracoumbilicus flap after fracture fixation and no infection .After 4 weeks,postoperative rehabilitative exercise was taken under the protection of orthosis .To improve the appearance and function of the foot and ankle ,plastic surgery of flaps were performed half a year later according to the condition of each flap.Results All the cases were followed up for 9 to 22 months(average,14.2 months).All the flaps sur-vived,except mild necrosis on the edge in 2 flaps.Through wound dressing,debridement,skin grafting,all flaps had good healing without any leakage .The healing process lasted for 12 to 34 d (average,17.1d ).The color of flaps was similar to the recipient site without any retraction and scar contracture .According to Maryland ' s scale,the sur-gery function was assessed ,showing excellent in 22 cases and good in 3 cases.Conclusion Due to its easy-access and wide coverage ,it is recommended to repair the large-area skin and soft tissue defect wound at foot and ankle with free thoracoumbilicus flap , which could significantly preserve the residual function of foot , and reduce the amputation rate .