Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea.
J Plast Reconstr Aesthet Surg. 2013 Mar;66(3):406-13. doi: 10.1016/j.bjps.2012.09.032. Epub 2012 Nov 7.
The plantar region presents unique challenges for reconstructive surgeons. Reconstruction using a thoracodorsal artery perforator (TDAP) flap yields favourable results in various fields of microsurgical reconstruction, but reports on the reconstruction of plantar defects are sparse. Here, the authors present their experience in the reconstruction of various defects in the plantar region using free TDAP flaps.
From January 2005 to July 2011, 40 free TDAP flaps were transferred for reconstructive purposes to restore skin and soft-tissue defects in the plantar region. Hospital and outpatient records were reviewed independently for all patients. A patient questionnaire including five questions was administered to subjectively evaluate reconstructive results.
A total of 24 male and 16 female patients were enrolled in this study. The mean age was 47.8 years and ranged from 7 to 77 years. The most common cause of defect was oncology related (n=21), followed by trauma-related (n=11), diabetes-related (n=6) and other causes. The average flap size was 63.7 cm2 and ranged from 25 to 212 cm2. All flaps survived except for one, resulting in a below-knee amputation. The mean follow-up period was 20.4 months. Four patients underwent secondary revisional procedures, including simple defatting in two patients and excision of redundant skin due to flap instability in two patients. The satisfaction surveys were completed by 34 (85%) patients. Patients reported high levels of satisfaction in terms of pain, limitation of daily activities, donor site satisfaction and overall satisfaction. Most patients were satisfied and reported that they would recommend the procedure to others.
An appropriately thinned free TDAP flap with thick skin provided favourable outcomes with high patient satisfaction and is a valuable option for the restoration of skin and soft-tissue defects in the plantar region.
足底区域给重建外科医生带来了独特的挑战。使用胸背动脉穿支（TDAP）皮瓣进行重建在各种显微重建领域都取得了良好的效果，但关于足底缺损重建的报道却很少。本文作者介绍了他们使用游离 TDAP 皮瓣重建各种足底缺损的经验。
自 2005 年 1 月至 2011 年 7 月，作者为重建目的转移了 40 个游离 TDAP 皮瓣，以修复足底区域的皮肤和软组织缺损。对所有患者的医院和门诊记录进行了独立回顾。通过问卷调查了 5 个问题来主观评估重建结果。
本研究共纳入 24 名男性和 16 名女性患者。平均年龄为 47.8 岁，年龄范围为 7 岁至 77 岁。缺损最常见的原因是肿瘤相关（n=21），其次是创伤相关（n=11）、糖尿病相关（n=6）和其他原因。平均皮瓣大小为 63.7cm2，范围为 25 至 212cm2。除 1 例因皮瓣不稳定性导致小腿以下截肢外，所有皮瓣均存活。平均随访时间为 20.4 个月。4 例患者接受了二次修正手术，其中 2 例患者行单纯去脂，2 例患者因皮瓣不稳定而行多余皮肤切除术。34 例（85%）患者完成了满意度调查。患者报告在疼痛、日常活动受限、供区满意度和总体满意度方面均有较高水平的满意度。大多数患者感到满意，并表示会向他人推荐该手术。
适当减薄的带厚皮的游离 TDAP 皮瓣具有良好的效果，患者满意度高，是修复足底皮肤和软组织缺损的一种有价值的选择。
