Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Microsurgery. 2011 Nov;31(8):610-5. doi: 10.1002/micr.20949. Epub 2011 Oct 18.
Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of complex soft-tissue defects of the foot is still challenging. The purpose of this report was to review the outcomes of free-flap reconstructive surgery for treating the metatarsal joint defects of the feet caused by chronic tophaceous gout.
Ten patients who had large tophus masses (>5 cm) and ulceration on the feet were admitted to our hospital between September 2006 and September 2010. Six patients underwent free-flap reconstruction after debridement to resurface the circumferential wound, protect the underlying structures, and provide a gliding surface for exposed tendons. The patients' age, sex, comorbidities, location and size of the defects, reconstructive procedures, surgical outcomes, complications, follow-ups, and recurrence of tophaceous gout were reviewed and recorded.
The mean patient age was 49.8 years (range, 36-72 years). The average skin defect size was 92.2 cm(2) . Five patients were treated using free anterolateral thigh flaps, and 1, using a free medial sural flap. These free flaps were safely raised and showed excellent functional and cosmetic results, with a mean follow-up of 31.7 months (range, 7-50 months).
Chronic tophaceous gout can cause severe skin infection and necrosis, even resulting in deformity or sepsis if left untreated. Surgical debridement is inevitable in patients with extensive wounds. We reconstructed the large, ulcerative skin and soft-tissue defects on the dorsum of the foot by performing free-flap reconstruction after adequate debridement and achieved good functional and cosmetic results.
足部大或广泛的痛风石可导致功能障碍、引流窦道和感染性坏死，最终导致伴有肌腱、关节、骨、神经和血管外露的复杂软组织缺损。足部复杂软组织缺损的重建仍然具有挑战性。本报告旨在回顾游离皮瓣重建手术治疗慢性痛风性痛风石引起的跖趾关节缺损的结果。
2006 年 9 月至 2010 年 9 月期间，我院收治了 10 例足部有大痛风石肿块（>5cm）和溃疡的患者。6 例患者在清创后行游离皮瓣重建，以覆盖环状创面，保护下方结构，并为外露肌腱提供滑动表面。回顾并记录患者的年龄、性别、合并症、缺损的位置和大小、重建程序、手术结果、并发症、随访和痛风石的复发情况。
患者平均年龄为 49.8 岁（范围 36-72 岁）。平均皮肤缺损面积为 92.2cm²。5 例患者采用游离股前外侧皮瓣治疗，1 例患者采用游离腓肠内侧皮瓣治疗。这些游离皮瓣安全掀起，功能和美容效果良好，平均随访 31.7 个月（范围 7-50 个月）。
慢性痛风石可导致严重的皮肤感染和坏死，如果不治疗，甚至会导致畸形或败血症。对于广泛伤口的患者，手术清创是不可避免的。我们通过充分清创后行游离皮瓣重建，对足部背侧的大、溃疡性皮肤和软组织缺损进行了重建，取得了良好的功能和美容效果。
