Vaienti Luca, Palitta Giovanni, Ravasio Giovanni, Randelli Pietro, Arrigoni Paolo
Department of Plastic and Reconstructive Surgery, University of Milan, Policlinico San Donato, San Donato Milanese, Italy.
Orthopedics. 2010 May 12;33(5). doi: 10.3928/01477447-20100329-24.
Plantar reconstruction is often challenging for plastic surgeons because of the peculiar anatomical features of this region. A large variety of reconstructive techniques for the plantar aspect of the foot have been described previously, including skin grafts, local flaps, fasciocutaneous flaps, perforator flaps, cross-limb flaps, and free flaps. This article presents a case of a 64-year-old patient with insulin-dependent diabetes who was involved in a traffic accident that resulted in a large plantar tissue defect (9x4 cm) extending to the base of the toes. After debridement of the wound, a subcutaneous flap was raised from the medial aspect of the lower leg in a sovrafascial plane. The flap was based on a double vascularization given by the great saphenous vein and by the perforator vessels from the posterior tibial artery, located anteriorly and inferiorly to the medial malleolus. The flap showed excellent vitality and long-term result with reduced donor site morbidity. We believe this flap represents a reliable surgical option in superficial plantar defects due to easy harvesting, short operative time, and minimal donor site morbidity. The subcutaneous flap of the distal medial fourth of the leg is a safe technique because of the vascular components of the pedicle. It provides durable coverage, mechanical resistance to pressure and shear stresses and, in selected cases (superficial defects, thin patients), is an interesting option to avoid major free flap procedures.
由于足底区域独特的解剖结构，足底重建对整形外科医生来说往往具有挑战性。此前已经描述了多种用于足部足底方面的重建技术，包括皮肤移植、局部皮瓣、筋膜皮瓣、穿支皮瓣、交叉肢体皮瓣和游离皮瓣。本文介绍了一例64岁的胰岛素依赖型糖尿病患者，该患者遭遇交通事故，导致足底出现一个大的组织缺损（9×4厘米），延伸至脚趾基部。伤口清创后，在小腿内侧的筋膜上平面掀起一个皮下皮瓣。该皮瓣基于大隐静脉以及位于内踝前下方的胫后动脉穿支血管提供的双重血供。该皮瓣显示出良好的活力和长期效果，供区并发症减少。我们认为，由于易于切取、手术时间短且供区并发症极少，该皮瓣是足底浅表缺损的一种可靠手术选择。由于蒂部的血管成分，小腿远内侧四分之一的皮下皮瓣是一种安全的技术。它能提供持久的覆盖、对压力和剪切应力的机械抵抗力，并且在某些情况下（浅表缺损、体型瘦的患者），是避免进行大型游离皮瓣手术的一个有吸引力的选择。
