Study of Peroneal Perforators in Children (60 Children & 100legs) With Hand Held Vascular Doppler Which Is Basis for Reverse Sural Artery Flap
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 3
Abstract
Abstract: The incidence of trauma is on increasing trend as a result of raise in Road traffic accidents. Now a day the complex injury of lower limbs in children is not rare condition. Reconstruction of such injuries is a big challenge to plastic & reconstructive surgeons.Reconstructive options available for such defects are “Conventional Pedicle Flap “or “MICRO VASCULAR FLAP”. In adults- RSA or Ext.RSA Flap literally challenged the Microvascular flap & proved its merit as an alternate option. But “Is it safe in children” the question need to be addressed.Vascular basis for RSA flap is reverse flow of blood from peroneal artery perforators in lower third of leg near lateral malleolus into vascular plexus around sural nerve. Locations of peroneal perforators in adults were well described in the Literature but not in children. This study is conducted to find out the pattern of peroneal perforators in children. The objectives are to study the location of Peronealperf.in the distal leg within 5 cm in relation with tip of Lateral malleolus and to know the need of modifications of flap design & Safety of RSA / Ext. RSA flaps in the children. This a Prospective clinical study conducted at Our Institute (Osmania General Hospital ) 60 children < 12 years who are normal & healthy included in the study &100 legs were studied with hand held vascular doppler for location of peroneal perforators conducted between - Jan – July 2016.Children are divided into 4 groups depending on age (Group - 1 - 1-3 yrs, Group –II - 4-6 yrs, Group – III - 7-9 yrs, Group – IV - 10-12 Yrs) and following parameters noted and analyzed 1) The length of leg, 2) No. of peroneal perf. Within 5 cm in relation with tip of lateral malleolus, 3) Inter perforator distance (IP Dis), 4) Location of dominant or Robust perforator. These observations compared with cadaveric dissection & surgical findings.The no. of perforators within 5 cm – decreased from GR-I to GR-IV with advancing age but minimum 2 present in all children ( unlike in Adults).The robust perforator is located very near to LM in GR-I at 3 cm migrated proximally to 5 cm in GR-IV- .RSA or Extended RSA flap are safer in Children than in adults in view of presence of minimum 2 peroneal perforators within 5 cm from lateral malleolus. Keywords:Reverse sural artery flap, peroneal perforators, Ext. Reverse sural artery flap
Authors and Affiliations
Palukuri Lakshmi, N. Naga Prasad, Sreedharala Srinivasa Satyanarayana, C. Baliram, Sugadha . , Sirisha . , Krishna Moorthy . V
Keywords
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