Schmidt I, Schmieder A, Kilian O
Department für Hand- und Fußchirurgie, Klinik für Orthopädie und Unfallchirurgie, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland.
Unfallchirurg. 2012 Mar;115(3):267-72. doi: 10.1007/s00113-011-2062-2.
Exposed bradytrophic tissue in regions with high mechanical loading is an indication for defect coverage with (myo-, adipo-) fasciocutaneous flaps. In this case, distally based sural flaps were used for bilateral coverage of defects in weight-bearing areas of feet after fourth-degree frostbite. Residual defects can be covered with a split skin mesh graft. The definitive prosthetic supply of the foot assumes a stabilized plantar soft tissue situation. Among its advantages in comparison to free microvascular flaps, the locally based fasciocutaneous flap can be harvested with less donor site morbidity after elevation and does not require secondary debulking. It has been shown that the reduced stability at the border zone between flap and mesh graft has an adverse effect.
在机械负荷较高的区域暴露的营养障碍性组织提示需用（肌、脂肪）筋膜皮瓣覆盖缺损。在此病例中，采用远端蒂腓肠皮瓣双侧覆盖四度冻伤后足部负重区的缺损。残余缺损可用中厚皮片移植覆盖。足部的最终假肢配置需要足底软组织情况稳定。与游离微血管皮瓣相比，局部带蒂筋膜皮瓣的优点在于掀起后供区并发症较少，且无需二次减容。研究表明，皮瓣与皮片移植交界处稳定性降低会产生不利影响。
