Siddiqi Muhammad Ather, Hafeez Kamran, Cheema Tahseen A, Rashid Haroon-Ur
Section of Orthopedic Surgery, Department of Surgery, Aga Khan University and Hospital, Karachi, Pakistan.
J Foot Ankle Surg. 2012 Nov-Dec;51(6):790-4. doi: 10.1053/j.jfas.2012.06.003. Epub 2012 Jul 12.
Coverage of the weightbearing heel poses a unique technical challenge to the reconstructive surgeon. In the present study, we share our clinical experience with the use of the medial plantar artery-based flap for coverage of tissue defects around the heel. Eighteen medial plantar artery flaps performed from January 1996 to December 2009 were included. All the procedures were performed by 2 surgeons at Aga Khan University and Hospital (Karachi, Pakistan) and Bahawal Victoria Hospital (Bahawalpur, Pakistan). Of the 18 patients, 16 were male and 2 were female. The indications were traumatic loss of the heel pad in 13, pressure sores in 2, and unstable plantar scars in 3. All the flaps were raised as sensate fasciocutaneous pedicled flaps based on the medial plantar artery. All the flaps healed uneventfully without major complications. The donor site was covered with a split-thickness skin graft, and we had partial graft loss in 1 case. The sensate flaps had slightly inferior protective sensation compared with the normal side. From our results, we suggest that the medial plantar artery flap is a good addition to the existing armamentarium. It provides tissue to the plantar skin with a similar texture and an intact protective sensation. The technique is easier to master compared with free microvascular flaps and has less risk of any functional donor site morbidity.
负重足跟部的覆盖对重建外科医生来说是一项独特的技术挑战。在本研究中，我们分享了使用基于足底内侧动脉的皮瓣覆盖足跟周围组织缺损的临床经验。纳入了1996年1月至2009年12月期间实施的18例足底内侧动脉皮瓣手术。所有手术均由阿迦汗大学医院（巴基斯坦卡拉奇）和巴哈瓦尔维多利亚医院（巴基斯坦巴哈瓦尔布尔）的2名外科医生完成。18例患者中，男性16例，女性2例。适应证包括13例足跟垫创伤性缺失、2例压疮和3例足底不稳定瘢痕。所有皮瓣均作为基于足底内侧动脉的带蒂感觉筋膜皮瓣掀起。所有皮瓣均顺利愈合，无重大并发症。供区用中厚皮片覆盖，1例出现部分皮片丢失。感觉皮瓣的保护性感觉略逊于正常侧。根据我们的结果，我们认为足底内侧动脉皮瓣是现有技术手段的一个很好补充。它为足底皮肤提供质地相似且保护性感觉完整的组织。与游离微血管皮瓣相比，该技术更容易掌握，且供区出现功能障碍的风险更低。
