Işik S, Celiköz B, Demiroğullari M, Sengezer M, Selmanpakoğlu N
Department of Plastic, Reconstructive Surgery, Gülhane Military Medical Academy, Ankara, Turkey.
Ann Plast Surg. 1999 Jul;43(1):21-9. doi: 10.1097/00000637-199907000-00004.
Various alternative methods have been used for repair of extensive dorsal foot defects due to high-energy-induced injuries. The authors reconstructed such defects with free muscle transfers and skin grafts in 9 male patients (average age, 21.7 years) between the years 1995 and 1998. Patients (right foot, 5; left foot, 4) presented with injuries due to military rifle gunshot (N = 4), mine explosion (N = 2), high-voltage electricity (N = 2), and traffic accident (N = 1). The patient injured in a traffic accident was treated with skin grafting only, and experienced osteomyelitis and skin breakdown. The other 8 patients were injured acutely and were hospitalized within 3 weeks of injury. After serial debridement of necrotic tissues, surgery was performed at an average of 6 weeks postinjury. Metatarsal bone defects of 5 cm in 3 patients were repaired by iliac (N = 2) and fibular (N = 1) bone grafts. Free muscle latissimus dorsi (N = 4) and rectus abdominis (N = 5) flaps were transferred microsurgically. The transferred muscle flaps were covered with split-thickness skin grafts. Mean operation duration was 5 hours 12 minutes. All flaps survived. The average area of soft-tissue defect repaired was 93 cm2 (range, 36-231 cm2). Average follow-up was 25 months. No symptoms of osteomyelitis and skin breakdown were encountered in the 8 acutely injured patients. Monofilament sensory tests revealed diminished protective sensation in 5 patients and absence of protective sensation in 4 patients. Partial resorption of bone grafts occurred in 2 patients. Thinning of the flaps was performed by tangential excision in 2 patients whose muscle flaps did not diminish in thickness. All patients were able to wear normal shoes. The authors suggest the use of free muscle transfer in reconstructing extensive soft-tissue defects of the dorsal foot.
由于高能损伤导致的足背广泛缺损，已采用了各种替代方法进行修复。作者于1995年至1998年间，对9例男性患者（平均年龄21.7岁）采用游离肌肉移植和皮肤移植重建此类缺损。患者（右脚5例；左脚4例）因军用步枪枪击伤（4例）、地雷爆炸伤（2例）、高压电击伤（2例）和交通事故伤（1例）就诊。1例交通事故伤患者仅接受了皮肤移植治疗，出现了骨髓炎和皮肤破溃。其他8例患者为急性损伤，伤后3周内入院。在对坏死组织进行系列清创后，平均伤后6周进行手术。3例跖骨缺损5 cm的患者，分别采用髂骨（2例）和腓骨（1例）移植修复。显微外科转移了背阔肌（4例）和腹直肌（5例）游离肌皮瓣。转移的肌皮瓣覆盖中厚皮片。平均手术时间为5小时12分钟。所有皮瓣均存活。修复的软组织缺损平均面积为93 cm²（范围36 - 231 cm²）。平均随访25个月。8例急性损伤患者未出现骨髓炎和皮肤破溃症状。单丝感觉测试显示，5例患者保护性感觉减退，4例患者无保护性感觉。2例患者出现骨移植部分吸收。2例肌皮瓣厚度未减薄的患者，通过切线切除进行了皮瓣减薄。所有患者均能穿正常鞋子。作者建议采用游离肌肉移植重建足背广泛软组织缺损。
