[Anatomic study of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects].
OBJECTIVE
To study the anatomy of peroneal tendofascial flap combined with adipofascial flap for the repair of heel tissue defects.


METHODS
The lower extremities of five cadavers (10 sides) were perfused with red latex, the blood supply of peroneal tendofascial flap and vicinity adipofascial flap were observed. The diameter, course, branches and location of the blood vessels were measured. Eight fresh cadavers (16 sides) were perfused with lead oxide-gelatine mixture. The covering fascia tissues of the lower extremities was obtained and photographed by X-ray. The vascular anastomosis and association of nutrient vessel of peroneal tendofascial flap and vicinity adipofascial flap were observed. Two adult lower extremities specimens (4 sides) were used to construct vessel diagrams for observation of the course, distribution and anastomosis of the vessels. Eight cases were treated successfully with theses flaps.


RESULTS
The blood supply of the combined fascial flap is multi-originated. For the area within 4 cm below and above the lateral malleolus cusp, the blood supply includes 2-5 branches from heel lateral artery with an average diameter of (0.5 +/- 0.2) mm, 1-2 branches from posterior lateral malleolus artery with an average diameter of (0.6 +/- 0.2) mm and 2-3 branches from the descending part of perforating branches of peroneal artery with an average diameter of (0.5 +/- 0.2) mm. The blood supply of area 4 cm above lateral malleolus cusp is 1-3 branches from intermuscular septum perforating branches of peroneal artery with an average diameter of (1.0 +/- 0.2) mm. These above branches are anastomosed each other and also send off many smaller branches to form vascular net around tendon. The fascial flaps and free skin grafts in eight patients were completely survived. All patients were followed up for 3-24 months, the donor and recipient sites were healed very well. The functional and cosmetic results were satisfactory.


CONCLUSIONS
Peroneal tendofascial flap combined with adipofascial flap, with proximal pedicle or reverse distal pedicle, can be used to repair the defect at the lower leg and refractory small- and medium-sized defects at the heel.
Zuo
Zong-Bao
ZB
Department of Plastic Surgery of First Affiliated Hospital of Anhui Medical University, Hefei, China.
Cui
Huai-Rui
HR
Li
Xiao-Jing
XJ
Ning
Jin-Long
JL
Tang
Mao-Lin
ML
Zhang
Lin
L
Zhu
Fei
F
D000273:Adipose Tissue / Q000033:anatomy & histology / Q000637:transplantation; D000328:Adult; D000368:Aged; D005205:Fascia / Q000033:anatomy & histology* / Q000637:transplantation*; D005260:Female; D005360:Fibula; D006365:Heel / Q000293:injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013524:Surgical Flaps