Clinical application of tissue flaps pedicled with posterior tibial artery perforators by different surgical types in the lower leg

XU Xiaohan; LI Pandeng; LI Zhihua

doi:10.3969/j.issn.1673-7040.2025.07.004

Abstract：Objective To exploring the design of tissue flaps based on perforating vessels of the posterior tibial artery in different surgical procedures,and their clinical application effects and indications in calf repair.Methods From February 2020 to February 2022,Department of Burn Plastic Surgery,The Affiliated Hospital of Xuzhou Medical University,35 perforator tissue flaps of the posterior tibial artery perforator tissue flaps were used to repair defects in the lower leg in 35 patients.Posterior tibial artery perforator flaps carrying partial gastrocnemius muscle were transplanted to cover soft tissue defects with dead spaces in the ankle and foot in 8 patients.V-Y advanced flap with pedicle of posterior tibial artery were used to repair wounds with exposed bone in anterior tibial area in 9 patients.Distally based pos-terior tibial artery perforator flaps were used to cover the achilles region defects in 6 patients.Proximally based posterior tibial artery perfo-rator flaps were used to cover pre-tibial defect in 4 patients.Posterior tibial artery perforator-pedicled propeller flaps were used to repair the defects in the achilles region and pre-tibial area in 4 patients.Distal pedicle direct distal flaps(cross leg flaps)were used to repair wounds in lower leg and the dorsum of the foot in 8 patients.The main points of the operation and the clinical indications of different surgi-cal methods were summarized.Results All patients flaps were good in appearance and the curative effect is satisfactory.Distal venous blood stasis occurred in 2 patients and the distal end of the flap with a little epidermis necrosis occurred in 1 patient within 24 hours after operation.Among them,2 patients healed about 3 weeks after routine dressing change,and 1 case healed after secondary skin grafting after dressing change.Conclusion The tissue flap pedicled with the perforator of posterior tibia artery was free,flexible and reliable in design.It can be used to repair skin and soft tissue defects in front of knee joint,lower leg,ankle region and contralateral lower leg.The clinical in-dications of different surgical methods were summarized:(1)V-Y advanced flaps,propeller flaps pedicled perforators,flaps pedicled with proximal and distal perforators were suitable for repairing wound in the ipsilateral lower leg.(2)Posterior tibial artery perforator flaps carry-ing partial gastrocnemius muscle were suitable for repairing soft tissue defects with dead spaces in the ipsilateral lower leg.(3)Distal pedicle direct distal flaps(cross leg flaps)were suitable for repairing larger soft tissue defects in the contralateral legs.