Clinical efficacy of the fifth metatarsal perforator flap of the lateral plantar artery on repairing the anterolateral forefoot wound

Niu Xuetao; Zhao Juhui; He Xiao; Mu Huan; Yu Hong; Ma Xianjie; Zhao Dingxue; Zhang Xiaofeng

doi:10.3760/cma.j.cn501225-20240607-00217

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Niu Xuetao,Zhao Juhui,He Xiao,et al.Clinical efficacy of the fifth metatarsal perforator flap of the lateral plantar artery on repairing the anterolateral forefoot wound[J].Chin J Burns Wounds,2025,41(4):1-7.DOI: 10.3760/cma.j.cn501225-20240607-00217.

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Clinical efficacy of the fifth metatarsal perforator flap of the lateral plantar artery on repairing the anterolateral forefoot wound

doi: 10.3760/cma.j.cn501225-20240607-00217

1.
Department of Plastic Surgery, Hanzhong Central Hospital, Hanzhong 723000, China
2.
Department of Orthopedics and Arthrology, Hanzhong Central Hospital, Hanzhong 723000, China
3.
Department of Plastic Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

Shaanxi Province Health and Wellness Research Innovation Capability Enhancement Planning Project 2024PT-16

Received Date: 2024-06-07
Available Online: 2025-04-03

Abstract

Abstract

Objective To evaluate the clinical efficacy of the fifth metatarsal perforator flap of the lateral plantar artery on repairing the anterolateral forefoot wounds. Method This study was a retrospective observational study. Eight patients with skin and soft tissue defects on the anterolateral forefoot and conformed to the inclusion criteria were admitted to the Department of Plastic Surgery of Hanzhong Central Hospital from July 2020 to July 2023. There are 6 males and 2 females, aged 22 to 72 years. Among the patients, there were three patients with electrical burns, four patients with trauma, and one patient with plantar wart. Preoperatively, a Doppler blood flow detector was used to clarify the number and location of the fifth metatarsal perforating vessels. The area of the wound measured during the operation ranged from 4.0 cm×3.0 cm to 7.0 cm×5.0 cm, and the fifth metatarsal perforator flap of the lateral plantar artery with area of 4.0 cm×4.0 cm to 9.0 cm×6.0 cm was designed and harvested to repair the wound. The wound in the flap donor sites was repaired with medium-thickness skin graft from lower limb on the same side. The duration of surgery and intraoperative blood loss volume were recorded. The survivals of the transplanted flap and skin graft were observed after surgery. At the last follow-up, the appearance of the flap and the occurrence of complication were observed, the two-point discrimination distance of the flap was measured, and the shape of the flap donor site as well as the sensation and function of the foot were observed. Results The duration of surgery ranged from 70 to 100 min, with an average of 84.6 min. The intraoperative blood loss volume ranged from 30 to 80 mL, with an average of 53.5 mL. After surgery, all flaps survived completely; one patient developed partial necrosis of the skin graft in the flap donor site, and the wound healed completely after dressing change and re-grafting medium-thickness skin graft from lower limb on the same side. Postoperative follow-up was conducted for 6 to 24 months, with an average of 13.8 months. At the last follow-up, the flaps in all patients showed no swelling or deformity, without occurrence of pressure ulcer, and the two-point discrimination distance of the flap ranged from 5 to13 mm. There were no tendon adhesion or scar hyperplasia in the flap donor site, and the patients had normal sensation, weight-bearing ability, and walking function. Conclusions The use of the fifth metatarsal perforator flap of the lateral plantar artery for repairing the anter olateral fore foot wound had the advantages of flexible flap design, minimal damage to the flap donor site, simple and feasible surgical operation, and good postoperative foot appearance and function, which is worthy of clinical application and promotion.
- Wounds and injuries,
- Forefoot, human,
- Perforator flap,
- Wound repair

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