Kuran I, Turgut G, Bas L, Ozkan T, Bayri O, Gulgonen A
Plastic and Reconstructive Surgery Clinic, Sisli Etfal State Hospital, Plastic and Reconstructive Surgery Department, Istanbul, Turkey.
Plast Reconstr Surg. 2000 Feb;105(2):574-80. doi: 10.1097/00006534-200002000-00015.
In this study, 12 cases of reconstruction of the heel and plantar area since 1982 are reviewed. Six nonsensate muscle free flaps and six sensate fasciocutaneous flaps were used, respectively. Categories assessed were the time interval for return to daily living activities, sensation to light touch, pinprick, Semmes-Weinstein monofilament test of the reconstructed area for sensory evaluation; and results of pedograms (maximal pressure, pressure distribution, and total contact area of the plantar surface). Follow-up periods were between 2 and 14 years, with an average of 6 years. Better sensory results and early return to daily living activities were observed in the sensate flap group, but the defects were smaller in this group. Despite the slightly longer time to return to daily living activities and worse sensory results, long-term follow-up showed that patients with nonsensate flaps had no difficulty in performing living activities if they continued to be careful and to use some kind of protective shoes. The results of the pedogram analyses were similar between the two groups with regard to total contact area of the reconstructed foot in relation to the healthy foot. Pressure values of the reconstructed areas in sensate flaps were found to be close to pressure values in the same weight areas of the normal foot. The differences between pressure values of the sensate and nonsensate flaps were statistically significant (p < 0.001). Therefore, in reconstruction of the weight-bearing surface of the foot, each case should be evaluated individually. The reconstructive method should be chosen according to the location and soft-tissue requirements of the defect.
本研究回顾了自1982年以来12例足跟及足底区域重建的病例。分别使用了6个无感觉的游离肌皮瓣和6个有感觉的筋膜皮瓣。评估的类别包括恢复日常生活活动的时间间隔、对轻触、针刺的感觉、用于感觉评估的重建区域的Semmes-Weinstein单丝试验；以及足印图结果（最大压力、压力分布和足底表面的总接触面积）。随访期为2至14年，平均6年。有感觉皮瓣组观察到更好的感觉结果和更早恢复日常生活活动，但该组的缺损较小。尽管恢复日常生活活动的时间稍长且感觉结果较差，但长期随访表明，无感觉皮瓣的患者如果继续小心并使用某种防护鞋，进行生活活动并无困难。两组足印图分析结果在重建足与健足的总接触面积方面相似。发现有感觉皮瓣重建区域的压力值接近正常足相同重量区域的压力值。有感觉和无感觉皮瓣的压力值差异具有统计学意义（p < 0.001）。因此，在足部负重面重建中，应针对每个病例进行单独评估。应根据缺损的位置和软组织需求选择重建方法。
