Herlin C, Lievain L, Qassemyar Q, Michel G, Assaf N, Sinna R
Service de chirurgie plastique, reconstructrice et esthétique, hôpital Nord, CHU d'Amiens, place Victor-Pauchet, Amiens cedex 1, France.
Ann Chir Plast Esthet. 2013 Aug;58(4):283-9. doi: 10.1016/j.anplas.2012.08.005. Epub 2012 Sep 16.
Heel coverage requires the surgeon to considerate of multiple parameters: the type of defect, the exposed tissues, the weight-bearing requirements, the donor site morbidity, and the shape of the reconstructed heel allowing at best normal footwear. Although many methods of coverage exist, they are often chosen at the cost of a compromise between all the parameters described. In recent years, perforator freestyle free flaps offer plastic surgeons an unparalleled freedom that can adapt the constraints of the reconstruction while minimizing the functional and scar donor site morbidity.
We present four cases of heel defect of different origins treated by three types of tailored perforator freestyle free flaps (ALT, TAP and SCIP Flaps). End-to-side anastomosis to the posterior tibial vessels was used in three flaps while one flap was anastomosed to the internal plantar artery in an end-to-end fashion.
No postoperative complication occurred. This approach allowed, in all patients, a reconstruction of excellent quality with minimal cicatricial morbidity. All patients were walking effectively at 21 days postoperatively.
Perforator freestyle free flaps offer a solution of first choice for heel reconstruction. At the price of a linear hidden scar, they offer a functional, aesthetic and durable coverage.
足跟覆盖需要外科医生考虑多个参数：缺损类型、暴露组织、负重需求、供区并发症以及重建足跟的形状，以尽可能实现正常穿鞋。尽管存在多种覆盖方法，但往往是以牺牲上述所有参数之间的平衡为代价来选择的。近年来，穿支游离皮瓣为整形外科医生提供了无与伦比的自由度，能够在适应重建限制的同时，将供区功能和瘢痕并发症降至最低。
我们展示了4例不同病因的足跟缺损病例，采用了3种定制的穿支游离皮瓣（股前外侧皮瓣、旋髂浅动脉穿支皮瓣和腹壁下动脉穿支皮瓣）进行治疗。3例皮瓣采用与胫后血管端侧吻合，1例皮瓣采用与足底内侧动脉端端吻合。
未发生术后并发症。该方法使所有患者均获得了高质量的重建，瘢痕并发症极少。所有患者术后21天即可有效行走。
穿支游离皮瓣为足跟重建提供了首选解决方案。以线性隐蔽瘢痕为代价，它们提供了功能性、美观且持久的覆盖。
