Hong Joon Pio, Kim Eun Key
Seoul, Korea From the Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Plast Reconstr Surg. 2007 Jan;119(1):186-193. doi: 10.1097/01.prs.0000244856.98170.9c.
The goal of sole reconstruction should be functional and aesthetic. These goals can be achieved by providing the sole with a durable and comfortable weight-bearing surface, adequate contour, protective sensation, and solid anchoring to deep tissue to resist shearing. Various flaps such as fasciocutaneous, musculocutaneous, or split skin grafted muscle flaps have been reported for reconstruction of the weight-bearing foot. The perforator flap, however, deserves attention in the debate for the ideal flap because of its anatomical characteristics.
Between June of 2002 and February of 2005, 69 patients were treated for soft-tissue defects in the plantar areas with anterolateral thigh perforator free flaps. Sensory nerve coaptation was performed in 17 cases. The follow-up period ranged from 4 to 38 months, with a mean of 14.7 months.
Satisfactory aesthetic and functional results were observed using 4- to 6-mm-thick anterolateral thigh perforator flaps. All flaps survived, with the exception of one case. Partial necrosis and dehiscence of the wound developed in three cases, but secondary healing was achieved and final outcome was not impaired. Partial weight bearing began at 3 weeks, and acceptable gait recovery was noted by 3 months as evaluated by clinical observation and gait analysis. Most patients regained protective sensation by 12 months regardless of nerve coaptation, but earlier sensory recovery was noted in patients who underwent reconstruction with sensate flaps.
This article suggests the anterolateral thigh perforator flap to be a reliable option in sole reconstruction, resulting in an acceptable functional and aesthetic outcome.
足底重建的目标应兼具功能与美观。通过为足底提供耐用且舒适的负重表面、合适的轮廓、保护性感觉以及与深部组织的牢固锚定以抵抗剪切力，可实现这些目标。已有多种皮瓣，如筋膜皮瓣、肌皮瓣或断层皮片移植肌皮瓣用于负重足部的重建报道。然而，穿支皮瓣因其解剖学特征，在理想皮瓣的讨论中值得关注。
2002年6月至2005年2月期间，69例患者采用游离股前外侧穿支皮瓣治疗足底软组织缺损。17例患者进行了感觉神经吻合。随访时间为4至38个月，平均14.7个月。
使用4至6毫米厚的股前外侧穿支皮瓣观察到了满意的美观和功能效果。除1例患者外，所有皮瓣均存活。3例患者出现伤口部分坏死和裂开，但实现了二期愈合，最终结果未受影响。3周开始部分负重，通过临床观察和步态分析评估，3个月时步态恢复可接受。无论是否进行神经吻合，大多数患者在12个月时恢复了保护性感觉，但接受感觉皮瓣重建的患者感觉恢复更早。
本文表明股前外侧穿支皮瓣是足底重建的可靠选择，可带来可接受的功能和美观效果。
