Torrance and Stanford, Calif. From the Division of Plastic and Reconstructive Surgery, Harbor-University of California Los Angeles Medical Center, University of California, Los Angeles, and the Hagey Laboratory for Pediatric Regenerative Medicine, Plastic and Reconstructive Surgery, Stanford University School of Medicine.
Plast Reconstr Surg. 2011 Feb;127(2):723-730. doi: 10.1097/PRS.0b013e3181fed76d.
Reconstruction of the heel represents a difficult challenge for surgeons, given the demand for thick, durable skin capable of withstanding both pressure and shear. The authors describe the use of a sensate medial plantar flap for heel reconstruction in three patients and document the long-term retention of sensation compared with the contralateral uninjured heel and corresponding donor site.
A medial plantar flap was harvested to include the branch of the medial plantar nerve to the instep to preserve innervation. Sharp pain, light and deep pressure, vibration, cold temperature, and static and dynamic two-point discrimination were examined between 6 months and 1 year after surgery.
Sharp pain, vibration, and deep pressure sensation were present equally in the medial plantar flap, contralateral heel, and contralateral instep. Cold perception, light pressure, and static two-point and dynamic two-point discrimination were significantly less in the normal contralateral heel when compared with the heel reconstructed by the innervated flap. There were no significant differences in sensation between the medial plantar flap and the contralateral instep.
The medial plantar flap is capable of providing durable, sensate coverage of plantar hindfoot defects with minimal donor-site morbidity. Furthermore, that sensation remains identical to that of the instep donor site and superior to that of the normal heel pad.
由于需要能够承受压力和剪切力的厚而耐用的皮肤，因此对于外科医生来说，脚跟重建是一个具有挑战性的难题。作者描述了在三名患者中使用有感觉的足底内侧皮瓣进行脚跟重建，并记录了与对侧未受伤的脚跟和相应供体部位相比感觉的长期保留情况。
采集足底内侧皮瓣，包括到脚背的内侧足底神经分支，以保留神经支配。术后 6 个月至 1 年内检查锐痛、轻压和深压、振动、冷觉、静态和动态两点辨别觉。
足底内侧皮瓣、对侧脚跟和对侧脚背的锐痛、振动和深压感觉相等。与受神经支配的皮瓣重建的脚跟相比，正常对侧脚跟的冷觉、轻压、静态两点和动态两点辨别觉明显较差。足底内侧皮瓣与对侧脚背之间的感觉没有差异。
足底内侧皮瓣能够为足底后足缺损提供耐用、有感觉的覆盖，且供体部位的发病率较低。此外，这种感觉与脚背供体部位相同，优于正常的脚跟垫。
