Arch Hand Microsurg.  2018 Dec;23(4):290-295. 10.12790/ahm.2018.23.4.290.

Survival of Neuro-Venous Flap without Perforator due to Accidental Division of Perforator

• Byeon JY
• Choi HJ

• KMID: 2427397
• DOI: http://doi.org/10.12790/ahm.2018.23.4.290

Abstract

Author planed peroneal artery perforator flap for ankle reconstruction and experienced successful result using sural neuro-lesser saphenous venous flap due to an unexpected event. A male Asian patient, 24 years old, had a history of recurrent operation wound disruption in the ankle region. Under general anesthesia, peroneal perforator and saphenous vein, as well as the sural nerve branches, were identified and preserved. In the process of flap rotation, an accidental division of peroneal artery perforator has occurred. Despite the division of the perforator, circulation was normal. The patient experienced no complication after the surgery. Some study reported that accompanying arteries and the vascular plexus around the sural nerve communicate. In conclusion, sufficient blood supply was possible only with the accompanying artery of the sural nerve without peroneal perforator. So, it is essential to always preserve not only perforator but also neurovascular bundles at any circumstances and any location.

Keyword

Ankle; Reconstructive surgical procedures; Perforator flap; Wounds and injuries

MeSH Terms

Anesthesia, General
Ankle
Arteries
Asian Continental Ancestry Group
Humans
Male
Perforator Flap
Reconstructive Surgical Procedures
Saphenous Vein
Sural Nerve
Wounds and Injuries

Figure

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  Fig. 1 The patient presented with recurrent wound disruption after Achilles tendon surgery, and 1×2 cm skin defect and Achilles tendon were exposed behind the right ankle. Scar tissue around the skin defect was observed, and a purulent discharge was observed along the Achilles tendon.

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  Fig. 2 (A) The medial border of the flap was designed along with previous surgical scars, and the peroneal artery perforator was confirmed using Doppler then marked with a blue circle. A 17×6 cm fasciocutaneous flap was elevated. (B) The white arrow represents the peroneal artery perforator, and the black arrows represent the sural nerve. (C) During flap rotation, perforator was broken in an accident. Despite the division of the perforator, margin bleeding was confirmed at the flap margin and capillary refill time was also normal. Sural nerve and proximal channel of saphenous vein were preserved.

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  Fig. 3 (A) After flap inset, two hemovac were inserted, and the flap was repaired with 4-0 Nylon. The author used 6×2 cm sized split-thickness skin graft for defect area after flap elevation. A short leg splint was applied to the extensor part. (B) The patient experienced no complication after the surgery, and the esthetic results are considered good without any limitation to ankle movement.

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