Department of Plastic and Reconstructive Surgery, Hospital Militar Dr. Alejandro Dávila Bolaños, Managua, Nicaragua.
J Reconstr Microsurg. 2013 Oct;29(8):501-4. doi: 10.1055/s-0033-1348034. Epub 2013 Jun 11.
The use of local flaps for the reconstruction of leg has lost their popularity with the more often performed flaps on the basis of perforators and microsurgical technique. Like the head and neck reconstruction, in the lower extremity there are limited units of tissue to base the flaps because of the lack of vascularity and arc of mobilization. The distally based sural flap represents an ideal flap for the reconstruction of heel, and with the inclusion of the sural nerve, we can neurotize the flap to give the stability of a weight-bearing area and provide the necessary sensibility to avoid ulcerations of the reconstructed heel. We present a case of a 32-year-old woman with a traumatic loss of the tissue covering the heel, with a diagnosis of a pseudoepithelial hyperplasia treated in previous occasions with skin grafts that led to chronic ulcerations. A distally based sural flap was planned for a definitive coverage, planning a perineural neurorrhaphy, to the intermediate dorsal cutaneous branch of the superficial peroneal nerve to give sensibility to the flap.
局部皮瓣在下肢重建中的应用已经失去了其流行度，因为现在更多地采用了基于穿支和显微外科技术的皮瓣。与头颈部重建一样，由于下肢的血管供应和可移动范围有限，可供皮瓣使用的组织单位有限。远端蒂腓肠神经营养血管皮瓣是足跟重建的理想皮瓣，通过包含腓肠神经，我们可以对皮瓣进行神经化，使承重区域更加稳定，并提供必要的感觉，以避免重建足跟的溃疡。我们报告了一例 32 岁女性，因创伤导致足跟覆盖组织缺失，诊断为假性上皮增生，之前曾采用皮片移植治疗，但导致慢性溃疡。我们计划采用远端蒂腓肠神经营养血管皮瓣进行确定性覆盖，并计划进行神经吻合，将腓浅神经的中间背侧皮支与皮瓣吻合，以恢复皮瓣的感觉。
