Immediate foot reconstruction and revascularization of toes using an interposition superficial circumflex iliac artery perforator flow-through flap: A case report

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-07-24 DOI:10.1002/micr.31216
Kohei Mitsui MD, Chihena H. Banda MD, Kanako Danno MD, Kento Hosomi MD, Megumi Furuya MD, Mitsunaga Narushima MD, Ryohei Ishiura MD
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Abstract

Foot injuries, particularly degloving injuries, can lead to segmental loss of neurovascular structures in the toes, making simultaneous reconstruction of both the foot and toes challenging. This case report presents a technique using the superficial circumflex iliac artery perforator (SCIP) flap for immediate reconstruction of the dorsal foot and revascularization of multiple toes. A 28-year-old man suffered a degloving injury on the dorsum of his foot resulting in a 9 × 6cm skin defect, open fracture dislocations, exposure of tendons, and neurovascular injury, which included a 6–7.5 cm segmental defect of the vessels supplying the first, second, and third toes leaving all three toes ischemic. Immediate reconstruction was performed by harvesting a 12.5 × 5cm SCIP flap including both the superficial and deep branches and incorporating the superficial inferior epigastric vein (SIEV). The SCIP deep branch was used to revascularize the third and second toes and the SIEV vein graft used for the first toe. The patient recovered well, no complications were observed at the 2-year follow-up, preserving all three toes and regaining mobility. The use of the SCIP flap as a flow-through flap provides thin skin flap cover, good vessel caliber size match with digital vessels and reduces the need for vein grafts from distant sites improving surgical efficiency. These attributes make the flow-through interposition SCIP flap an excellent choice for reconstructing foot defects and revascularizing toes. We report this case to demonstrate the utility of the SCIP flap in immediate soft tissue cover and digit revascularization.

Abstract Image

使用髂浅周动脉穿孔带穿刺皮瓣立即进行足部重建和脚趾血管再造:病例报告。
足部损伤,尤其是脱臼损伤,可导致趾部神经血管结构的节段性缺失,使得同时重建足部和趾部具有挑战性。本病例报告介绍了一种使用髂浅周动脉穿孔器(SCIP)皮瓣立即重建足背并重建多个足趾血管的技术。一名 28 岁的男子脚背脱臼受伤,造成 9 × 6 厘米的皮肤缺损、开放性骨折脱位、肌腱外露和神经血管损伤,其中包括供应第一、第二和第三趾的血管出现 6-7.5 厘米的节段性缺损,导致所有三个趾缺血。通过采集一个 12.5 × 5 厘米的 SCIP 皮瓣,包括浅支和深支,并结合上腹部浅静脉(SIEV),立即进行了重建。SCIP 深支用于重建第三和第二脚趾,SIEV 静脉移植用于重建第一脚趾。患者恢复良好,两年随访时未发现并发症,保留了所有三个脚趾并恢复了活动能力。使用 SCIP 皮瓣作为穿流皮瓣,皮瓣覆盖层薄,血管口径大小与数字血管匹配,减少了从远处进行静脉移植的需要,提高了手术效率。这些特性使穿流插植 SCIP 皮瓣成为重建足部缺损和血管再通脚趾的绝佳选择。我们报告的这个病例证明了 SCIP 皮瓣在即时软组织覆盖和指骨血管再造中的实用性。
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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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