El-Shazly Mohamed, Yassin Osama, Kamal Ahmed, Makboul Mohamed, Gherardini Giulio
Department of Plastic Surgery, Assiut University Hospital, Assiut, Egypt.
J Foot Ankle Surg. 2008 Mar-Apr;47(2):145-52. doi: 10.1053/j.jfas.2007.12.010.
The hindfoot is a special anatomical location, requiring unique forms of reconstruction of the thick, durable heel pad, the underlying calcaneus, and the Achilles tendon and its thin, pliable soft tissue envelope. Perhaps more than in any other region of the foot, the heel poses a reconstructive challenge to the surgeon who must consider both form and function when repairing wounds in this location. There are many possible reconstructive options, including local, distant, and free flaps. These flaps could be of muscular, myocutaneous or fasciocutaneous tissues. We reconstructed heel defects in 46 consecutive patients using several reconstructive options, and reviewed the results. Patients were classified according to preoperative demographic variables, including size, depth, site, etiology, age, vascularity, sensation, Achilles tendon condition, bone exposure or bone loss, and the patient's functional needs. Neither partial nor total flap losses were observed; the reconstructions were evaluated and considered satisfactory both by surgeons and patients if they fulfilled certain criteria, namely complete coverage, durability upon weight bearing and walking, sensation, donor site morbidity, and cosmetic appearance. No recurrences of the defects were observed during the follow-up period. Heel reconstruction is a challenging task for foot and ankle reconstructive surgeons. Every step should be taken to avoid recurrences and ulcerations. In this article we present a surgical reconstruction algorithm that may allow easy and reliable decision making based on the preoperative assessment of the defect and other clinical features.
后足是一个特殊的解剖部位，需要对厚实、耐用的足跟垫、其下方的跟骨、跟腱及其薄而柔韧的软组织包膜进行独特形式的重建。与足部的任何其他区域相比，足跟对外科医生来说更具重建挑战，外科医生在修复该部位的伤口时必须同时考虑形态和功能。有许多可能的重建选择，包括局部、远处和游离皮瓣。这些皮瓣可以是肌肉、肌皮或筋膜皮组织。我们使用多种重建选择对46例连续患者的足跟缺损进行了重建，并回顾了结果。根据术前人口统计学变量对患者进行分类，包括大小、深度、部位、病因、年龄、血管状况、感觉、跟腱状况、骨外露或骨质缺损以及患者的功能需求。未观察到部分或全部皮瓣丢失；如果重建符合某些标准，即完全覆盖、负重和行走时的耐用性、感觉、供区并发症和外观，外科医生和患者均评估并认为其令人满意。随访期间未观察到缺损复发。足跟重建对足踝重建外科医生来说是一项具有挑战性的任务。应采取一切措施避免复发和溃疡。在本文中，我们提出了一种手术重建算法，该算法可根据术前对缺损和其他临床特征的评估进行轻松可靠的决策。
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