Benito-Ruiz J, Yoon T, Guisantes-Pintos E, Monner J, Serra-Renom J M
Department of Plastic and Maxillofacial Surgery, Hospital Clinic, Barcelona, Spain.
Ann Plast Surg. 2004 Apr;52(4):380-4. doi: 10.1097/01.sap.0000105520.24063.bb.
Soft tissue heel defects reconstruction represents a challenge for plastic surgeons because of the poor availability of regional tissue to perform the reconstruction. We divide the heel on the anterior or weight-bearing heel and the posterior or non-weight-bearing heel. Our preferences are the fasciocutaneous instep flap for anterior heel defects and the reverse sural flap for posterior heel defects. We have performed 11 reconstructions of the heel. The complications were total necrosis of 1 instep flap in a previously irradiated patient and 1 case of partial tip necrosis in a reverse sural flap. Functional recovery has been very satisfactory for both procedures. Regional island flaps are for us the first therapeutic option because the skin is similar to the lost one and less time consuming than a free-flap reconstruction.
由于用于重建的局部组织来源有限，足跟软组织缺损的重建对整形外科医生来说是一项挑战。我们将足跟分为足跟前部或负重区以及足跟后部或非负重区。对于足跟前部缺损，我们更倾向于采用足背筋膜皮瓣；对于足跟后部缺损，则采用腓肠神经营养血管逆行岛状皮瓣。我们共进行了11例足跟重建手术。并发症包括1例既往接受过放疗患者的足背皮瓣完全坏死，以及1例腓肠神经营养血管逆行岛状皮瓣的部分皮瓣尖坏死。两种手术的功能恢复情况都非常令人满意。对我们来说，局部岛状皮瓣是首选的治疗方法，因为其皮肤与缺损皮肤相似，且比游离皮瓣重建耗时更少。
