Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University, 896 Pyeungandong Donangu Anyangsi Gyeonggido,431-796, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2011 Feb;64(2):248-54. doi: 10.1016/j.bjps.2010.04.013. Epub 2010 May 31.
The medial plantar flap serves as an ideal tissue reserve for reconstructing the weight-bearing plantar areas as these areas require a sensate and glabrous skin. Furthermore, the flap provides tissue that is structurally similar to the plantar foot as it is also composed of thick glabrous plantar skin, shock-absorbing fibro-fatty subcutaneous tissue and plantar fascia. During the past 25 years, 20 patients (10 men, 10 women) with skin and soft-tissue defects over the weight-bearing plantar foot were treated. They ranged in age from 20 to 70 years (mean, 31.5 years). The causes of the defects were trauma (n=14) and malignant tumour (n=6); the defects were localised at the heel (n=16) and plantar forefoot (n=4). The medial plantar flap was transposed to the defects in three different ways: proximally pedicled sensorial island flaps (n =8), distally pedicled sensate island flaps based on the lateral plantar vessel (n =3) and neurovascular free flaps (n =9). Flap size varied from a width of 4-8cm and a length of 6-12cm. The mean size of the medial plantar flap was 49.5cm(2) (range, 28-96cm(2)). The follow-up period ranged from 6 to 80 months (mean, 19.9 months). Partial flap loss was observed in two proximally pedicled sensorial island flaps and one distally pedicled sensate island flap. Two free flaps restored normal sensation within 5 years of surgery. Minor skin graft loss at the donor site was observed in seven patients. However, no revision or re-grafting was performed. Hyperkeratosis was observed in one case. All patients achieved normal gait within 3 months after surgery and none noticed recurred ulceration. Durable, sensate coverage of the defects was achieved in all patients. We advocate variable sensate medial plantar flaps for the reconstruction of moderate-size defects of the weight-bearing plantar subunits.
足底内侧皮瓣是重建承重足底区域的理想组织储备，因为这些区域需要感觉灵敏且无毛的皮肤。此外，该皮瓣提供的组织在结构上与足底相似，因为它也由厚的无毛足底皮肤、减震的纤维脂肪皮下组织和足底筋膜组成。在过去的 25 年中，我们治疗了 20 例（10 男，10 女）承重足底皮肤和软组织缺损的患者。他们的年龄在 20 至 70 岁之间（平均 31.5 岁）。缺损的原因是创伤（n=14）和恶性肿瘤（n=6）；缺损位于足跟（n=16）和足底前足（n=4）。通过三种不同的方式将足底内侧皮瓣转移到缺损部位：近端带蒂感觉岛状皮瓣（n=8）、基于足底外侧血管的远端带蒂感觉岛状皮瓣（n=3）和神经血管游离皮瓣（n=9）。皮瓣的大小从 4-8cm 宽和 6-12cm 长不等。足底内侧皮瓣的平均大小为 49.5cm²（范围 28-96cm²）。随访时间为 6 至 80 个月（平均 19.9 个月）。观察到两个近端带蒂感觉岛状皮瓣和一个远端带蒂感觉岛状皮瓣部分皮瓣坏死。两个游离皮瓣在手术后 5 年内恢复了正常感觉。7 例患者供区皮肤移植部分坏死。然而，没有进行修复或再次植皮。1 例患者出现角化过度。所有患者在手术后 3 个月内恢复正常步态，均未发现溃疡复发。所有患者均获得了缺损的持久、感觉灵敏的覆盖。我们提倡使用各种感觉灵敏的足底内侧皮瓣来重建承重足底亚单位的中等大小缺损。
