COMPARATIVE STUDY ON THE APPLICATION OF THE MODIFIED PEDICLE OF THE RETROGRADE SURAL NERVE NUTRIENT VESSEL FLAP AND THE TRADITIONAL METHOD IN SOFT TISSUE DEFECTS OF THE FOOT AND ANKLE

Abstract

Objective: This study aimed to evaluate the clinical efficacy of the modified pedicle of retrograde sural neurotrophic vascular flap in treating soft tissue defects of the foot and ankle, focusing on enhancing surgical techniques for flap incision and transfer. The primary objectives were to enhance functional outcomes, broaden the flap's application range, and minimize surgical complications, thereby improving the postoperative quality of life for athletic patients. Methods: A total of 83 athletic patients with soft tissue defects of the foot and ankle were enrolled from March 2022 to March 2023 in our hospital. Among them, 41 athletic patients were randomly assigned to the control group, undergoing retrograde sural neurotrophic vascular flap pedicle transplantation, while 42 athletic patients were assigned to the observation group, receiving retrograde modified sural neurotrophic vascular flap pedicle transplantation. Detailed demographic data, including gender, age, cause of injury, defect area, postoperative flap survival, foot and ankle function scores and grades, two-point recognition level, pedicle point foot circumference difference, and postoperative flap follow-up, were recorded for both groups. These data were complemented with insights from recent literature on sural neurotrophic vascular flap anatomy and clinical applications. Results: The observation group comprised 42 athletic patients, including 33 males and 9 females, with ages ranging from 7 to 77 years (mean age: 37.00 ± 3.39 years). The control group comprised 40 athletic patients, with 29 males and 11 females, aged between 3 and 78 years (mean age: 37.00 ± 3.46 years). There were no significant differences in clinical data between the two groups (P > 0.05). However, the observation group exhibited significantly higher AOFAS ankle scores, excellent and good rates, two-point recognition sense, and pedicle point foot circumference difference compared to the control group (all P < 0.05). Conclusion: The modified pedicle of the retrograde sural neurotrophic vascular flap introduced in this study effectively mitigates the "cat ear" shape during flap operation, thereby reducing compression on the peroneal perforator and small saphenous vein. This modification facilitates arterial pressure and venous return, leading to reduced postoperative flap swelling and improved ankle function. Compared to the traditional retrograde sural neurotrophic vascular flap method, the modified approach demonstrates higher clinical utility, warranting its promotion in clinical practice.