Transferring perforator fascial flap to repair skin soft tissue defect around ankle joint in elderly patients / 中华创伤杂志

ABSTRACT

Objective To evaluate the clinical effect of the perforator fascial flap of the lower leg for the repair of large skin and soft tissue defects around the ankle in the elderly.Methods A retrospective case series study was conducted on the clinical data of 23 elderly patients with skin and soft tissue defect around the ankle joint admitted to Xinhua Hospital (Chongming) Affiliated to Medical College of Shanghai Jiaotong University,from November 2013 to December 2017.There were 13 males and 10 females,aged 65-78 years (mean,71 years).The wound areas around the ankle joint ranged from 13.5 cm × 5.5 cm to 16.0 cm × 8.5 cm.According to the position,size,and shape of the wound area around the ankle joint of the lower leg,the perforator fascia flap was designed and transferred for repairing.The maximum flap area was 17.0 cm × 9.5 cm while the minimum area was 14.0 cm ×6.5 cm.According to the conditions of survivals of the skin flap,elasticity,color,appearance,infection control,donor site scar,skin sensation,joint activity,patient satisfaction,etc.,the ankle and foot function was evaluated by referring to Tornetta and other standards.Besides,the swelling degree of the flap was graded.Results A total of 21 flaps survived and the wound at both donor site and recipient site obtained stage Ⅰ union.Two cases of skin edge necrosis occurred at the distal end of the flap,and the wounds at the donor and recipient sites were completely healed after dressing change.The patients were followed up for 6-48 months,with an average of 15 months.The flaps had good survival,satisfactory shape,and small scar at donor site,with similar elasticity and color with the surrounding normal skin.Twenty patients were satisfied with the efficacy and three were fine with the outcome.In terms of functional evaluation of the ankle and foot,the results were excellent in eight patients,good in 12,and fair in three.Flap swelling grading was as follows:degree Ⅰ in 16 patients,degree Ⅱ in 5,and degree Ⅲ in 2 at the early stage;degree Ⅰ in 20 patients,degree Ⅱ in 2,and degree Ⅲ in 1 at the later stage.Conclusion In repairing large skin and soft tissue defects around the ankle in the elderly,the perforator fascia flap of the lower leg transferring is a convenient,safe,and reliable method with less damage,which can promote the wound healing and functional recovery of ankle and foot.