title: Superficial peroneal neurocutaneous flap based on an anterior tibial artery perforator for forefoot reconstruction.
abstract: The distally based superficial peroneal neurocutaneous (SPNC) island flap has been widely used for foot reconstruction. It is based on the descending branch of the peroneal artery perforator. However, damage to the perimalleolar vascularization or anatomic variations of the descending branch often causes flap necrosis. Because septocutaneous perforators from the anterior tibial artery participate in the vascular network of superficial peroneal nerve in the distal lower leg, a modified SPNC flap is designed based on the anterior tibial artery perforator. Seven patients with soft tissue defect over the forefoot were treated by this modified technique. Six patients had accompanied injuries at the lateral perimalleolar region, and 1 patient had an anatomic variation of the descending branch of the peroneal artery perforator. The size of defect ranged from 12 × 5 to 15 × 9 cm. All 7 flaps survived completely without complications. The size of the flaps ranged from 13 × 6 to 16 × 10 cm. No severe venous congestion occurred. The mean follow-up was 9.4 months (range, 6-14 months). All patients were satisfied with the texture and color of the flaps. Two patients complained about the thickness of the flaps, but did not want further operation. The donor sites healed uneventfully and no painful neuroma occurred. In conclusion, the modified SPNC flap based on an anterior tibial artery perforator is a feasible salvage procedure when the traditional design is unreliable. It can provide sufficient and superior coverage for large forefoot defect.
authors.affiliation: From the Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Jiao Tong University, Shanghai, China.
authors.forename: Chun-Yang
authors.initials: CY
authors.lastname: Wang
authors.forename: Yi-Min
authors.initials: YM
authors.lastname: Chai
authors.forename: Gen
authors.initials: G
authors.lastname: Wen
authors.forename: Pei
authors.initials: P
authors.lastname: Han
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010543:Peroneal Nerve / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply* / Q000294:innervation; D016909:Tibial Arteries / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult