Peroneal artery perforator propeller flap in repairing foot and ankle wounds

Zhang Xiangchao; Lu Zhaofeng; Zhao Huashan; Ou Changliang

doi:10.3969/j.issn.1009-4237.2025.03.011

Abstract：Objective To explore the clinical application and efficacy of peroneal artery perforator propel-ler flaps(PPF)in the repair of foot and ankle soft tissue defects.Methods This retrospective study was conduc-ted on 15 cases of foot and ankle soft tissue defects,which were repaired by peroneal artery PPF in the Emergency Department of the First Affiliated Hospital of Henan University of Science and Technology from Feb.2019 to Sep.2022.There were 9 males and 6 females aged 22-60(mean 38.5)years,with 10 cases of traffic accident injuries and 5 mechanical injuries.The sizes of the defect were 3.5 cm×4.5 cm to 8.5 cm×10.5 cm,and the flaps were prepared of 4.0 cm×5.0 cm to 9.0 cm×11.0 cm.All surgeries were completed in two stages.In the first stage,after debridement,vacuum sealing drainage(VSD)was applied for 5-7 days.When the granulation tissue became clean and dry,a peroneal artery PPF was designed to repair the wound defects in the second stage.The donor sites were directly sutured in 9 cases,repaired by relay flap in 4 cases,and by skin grafting in 2 cases.All patients were followed up regularly through outpatient visits or WeChat.The follow-up indicators included the appearance,aesthet-ics and texture of the skin flap,and the scar at the donor site.Results Among the 15 cases,12 flaps survived smoothly;poor blood supply of the flaps was observed in 2 cases due to pedicle compression after surgery,which sur-vived after exploration and adjustment of the pedicle to relieve compression;the remaining case reported slight nec-rosis at the distal end of the skin flap,which healed after dressing changes.During the follow-up,all the skin flaps had an aesthetic appearance,with no obvious pigmentation or swelling,and good texture and elasticity.According to the functional evaluation criteria for skin flaps of the Microsurgery Branch of the Chinese Medical Association,10 ca-ses were rated as excellent,4 as good,and 1 as fair.A linear scar can be seen in the donor area,with an average score of 2.0±0.3 by the Vancouver Scar Scale(VSS),and normal function.Conclusion The perforators of the peroneal artery have stable blood supply and are constant in position and abundant in number,and thus PPF can be harvested flexibly.It is an ideal method for repairing soft tissue defects at the foot and ankle.