Comparison Study of Two Perforator Flaps for Repair of Small and Medium-Sized Defects of Lower Leg and Ankle

Gong Zhongping; Yang Xiaoxi; Zhou Tong; Wang Hui

Abstract：Objective To compare the clinical effect of the keystone-design perforator island flap and posterior tibial artery perforator flap in repairing small and medium-sized defects of lower leg and ankle.Methods From April 2018 to June 2024,the clinical data of 60 patients with small and medium-sized defects of lower leg and ankle in second hospital of Tangshan were retrospectively analyzed.According to the different surgical techniques of wound repair,they were divided into the keystone group(30 cases)and posterior tibial artery group(30 cases).The cases repaired by the keystone-design perforator island flap in the keystone group,included 21 males and nine females,aged 25 to 68 years[mean(47.97±10.76)years].The wound area in the keystone group ranged from 2.5 cm× 1.5 cm to 6.0 cm×3.0 cm,with a mean of(9.36±3.31)cm2.The other cases repaired by posterior tibial artery perforator flap included 23 males and seven females,aged 28 to 65 years[mean(45.43±11.57)years].And the sizes of the defects in posterior tibial artery group ranged from 2.8 cm× 1.5 cm to 5.6 cm×3.2 cm,with an average of(8.94±3.03)cm2.The operation time,intraoperative blood loss,primary survival rate of the flaps,and static two-point discrimination(TPD)of the flaps,the Vancouver scar scale(VSS)scores of the flaps and donor sites appearance,and American orthopaedic foot and ankle society(AOFAS)ankle and hindfoot function score were compared between the two groups.Results All the operations were successfully completed between the two groups.The operative time of the flap harvested and the intraoperative blood loss in keystone group were less than those in posterior tibial artery group(P＜0.05).The primary survival rate of the flaps in keystone group(100％)was higher than that in posterior tibial artery flap group(80.00％),with a statistically significant difference(P＜0.05).The duration of follow-up time in keystone and posterior tibial artery group were(16.27±4.35)months and(15.90±2.75)months,respectively.At the final follow-up,the static TPD of the flap and VSS scores of the flap and donor site in keystone flap group(29.80±8.17)mm and(4.07±1.08),were better than(39.13±7.33)mm and(5.17±1.32)in posterior tibial artery group with a statistically significant difference(P＜0.05).The AOFAS of the injured limbs in keystone group were excellent in 27 cases and good in 3 cases,and excellent in 25 casesand good in 5 cases in posterior tibial artery group,with no statistically significant difference(P＞0.05).Conclusion Compared with the posterior tibial artery perforator flap,the keystone-design perforator island flap can provide a shorter operative time,less intraoperative blood loss,higher primary survival rate,and better sensation and appearance recovery,which is more suitable for repairing small and medium-sized defects of lower leg and ankle.