[Repair of small and medium-sized soft tissue defect in ankle with sural neurocutaneous vascular flap pedicled on main perforating branch of peroneal artery].

Objective: To investigate the operative techniques and clinical results of sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery in repairing small and medium-sized soft tissue defects in ankle.
Methods: From July 2004 to February 2007, 14 patients (9 males and 5 females, aged 19-53 years) with small and medium-sized soft tissue defects in ankle were treated, including 4 cases of skin necrosis caused by surgery for achilles tendon rupture, 3 soft tissue defects due to car accident, 2 crush injury due to falling heavy objects, 2 chronical infectious ulcer, 2 skin necrosis caused by surgery for calcaneus fracture and 1 melanoma resection in heel. Ranging from 4 cm x 2 cm to 9 cm x 5 cm and combing with exposure of either tendon or bone, the defects were in ankle areas (12 cases) and weight-bearing heel (2 cases). The time from injury to hospitalization was 12 days to 13 months, except 3 cases of emergency hospitalization. After thorough debridement, the sural neurocutaneous vascular flaps (13 cm x 5 cm - 36 cm x 6 cm ) pedicled on the perforating branch of peroneal artery was harvested to repair the defects. The donor sites were sutured directly.
Results: Postoperatively all the flaps survived, and all the donor sites and wounds healed by first intention. Over a 7-23 month follow-up period, the texture, appearance and color of the flaps in all cases were good, with two-point discrimination of 7-12 mm.The function of ankle obtained satisfactory recovery with normal in-shoe gait.
Conclusion: With a reliable blood supply, simple operative procedure, sound repair of wound and satisfactory recovery of limb function, the sural neurocutaneous vascular flap pedicled on the relatively higher and main perforating branch of peroneal artery is applicable for the repair of small and medium-sized defects in the ankle and weight-bearing area of heel, especially for patients who have no satisfactory perforating branch in lower position.