SLR - March 2011 - Albemar Espiritu
Reference: Chang Yeon Kim, Shenthilkumar Naidu, Youn Hwan Kim. Supermicrosurgery in peroneal and soleus perforator-based free flap coverage of foot defects caused by occlusive vascular diseases. Plastic and Reconstructive Surgery. 2010; 126(2):499-507
Scientific Literature Review
Reviewed by: Albemar Espiritu DPM
Residency Program: Cedars-Sinai Medical Center
Podiatric Relevance:
This retrospective study provides evidence for the use of peroneal and soleus perforator-based flaps as a viable limb salvage procedure for ischemic foot defects.
Methods:
From January 2008 to December 2009, 17 patients (mean age of 64 years; age range 28 to 77 years) were treated for foot defects secondary to occlusive vascular disease. All patients in the study displayed atherosclerosis, obliteration of main vessels, and lack of flow to the foot. These findings were confirmed by CT angiography and color Doppler ultrasound. Prior to reconstruction, foot wounds were excisionally debrided. In some cases, negative pressure wound therapy was applied for 2 weeks. Terminal branches of foot vessels of 1mm diameter were surgically explored and selected as a recipient pedicle. Flaps raised contained a donor site pedicle which was identified from either peroneal or soleus perforators. Vessel patency was confirmed with hand-held Doppler.
Results:
In 17 patients, a total of 18 flaps were raised in which 16 peroneal perforator-based flaps and 2 soleus perforator-based flaps were used. Fifteen flaps utilized septocutaneous perforators while 3 flaps used musculocutaneous perforators. Flaps ranged from 2x2cm to 4x8cm in size. Average pedicle length was 2.3cm. Surgery duration averaged 3.7 hours. Complications included one case of total flap loss and two cases of wound dehiscence.
Conclusion:
This study provides the efficacy and benefits of supermicrosurgery and perforator flap use. Moreover, the utilization of these procedures allow for expanded surgical limb salvage options for foot defects in ischemic limbs.