Repair of medial plantar wound with posterior tibial artery perforator combined with saphenous nerve nutrient vessel fascial flap

Objective To investigate the surgical technique and its clinical efficacy of the flaps with double blood supply through posterior tibial artery perforators and saphenous nerve nutrient vessels for the secondary stage repair of medial plantar defects. Methods Thirteen patients with medial plantar tissue defects, who were repaired by posterior tibial artery perforator flaps combined with saphenous nerve nutrient vascular fascia flaps from January, 2016 to December, 2018, were studied. The patients were 9 males and 4 females, aged 23-69 (mean age 36.9) years. All defects were near the tarsometatarsal joints in the medial planta, and the soft tissue defects were 4.5 cm× 5.0 cm-8.0 cm×14.0 cm in size. The donor sites were directly sutured or repaired with free graft of ipsilateral thigh full-thickness skin. All patients in this study were followed-up for 6-12 months to observe the function of affected limbs and the recovery of flap donor and recipient sites through outpatient visits and telephone reviews. Results All the 13 flaps survived successfully. One flap developed a small area of necrosis at the distal end, which was healed after partial stitch removal, decompression and dressing change. Another flap had shown purple bruises and tension blisters, surgical exploration was then performed to remove local hematoma and the flap survived after pedicle stitch removal and decompression. One flap received flap thinning and shaping at 8 months after surgery. All flaps showed normal in color, temperature, capillary reaction, soft in texture and without swollen appearance. The affected feet were not apparently restricted when walking, and the functions had satisfactory recovery. Conclusion Posterior tibial artery perforator flap carrying saphenous nerve and great saphenous vein is able to achieve higher and reliable flap survival and better blood supply. Anastomosis of the saphenous nerve carried by flap with cutaneous nerve of the recipient site helps to reconstruct the protective sensation of the flap, which is an effective approach in clinically repairing of the medial plantar defects. Key words: Posterior tibial artery perforator flap; Saphenous nerve nutrient vascular fascial flap; Medial plantar; Soft tissue defect; Repair