May J W, Halls M J, Simon S R
Plast Reconstr Surg. 1985 May;75(5):627-41. doi: 10.1097/00006534-198505000-00001.
Over the past 4 years at the Massachusetts General Hospital 18 patients have been treated for extensive defects (mean size 130 cm2) of the foot at or below the medial and lateral malleoli. These patients have been treated with free muscle flaps covered with thick split-thickness skin grafts. Full muscle flap survival has been seen in each patient, and all patients are currently ambulatory. A subgroup of nine patients are weight-bearing directly upon their skin grafts covering transferred muscle. All patients are walking without chronic breakdown over a mean follow-up of over 19 months with the exception of a single patient who has had breakdown in a region of redundant improperly tailored muscle flap. None of the skin grafted muscles has significant cutaneous sensibility. Detailed gait analysis of these patients has confirmed the weight-bearing capabilities of free muscle flaps with skin grafts and has proven to be an excellent method of foot reconstruction evaluation. It would appear from this study that cutaneous sensibility may not be necessary for successful reconstruction of the weight-bearing surface of the foot. This method of reconstruction should be considered when local tissues are not suitable for plantar foot reconstruction.
在过去4年里，马萨诸塞州综合医院对18例在内、外踝及以下部位存在大面积足部缺损（平均面积130平方厘米）的患者进行了治疗。这些患者接受了带厚中厚皮片覆盖的游离肌皮瓣治疗。每位患者的肌皮瓣均完全存活，目前所有患者均能行走。其中9例患者直接在覆盖移植肌肉的皮片上负重。除1例患者在多余且剪裁不当的肌皮瓣区域出现破溃外，所有患者在平均超过19个月的随访期内行走时皮肤均未出现慢性破溃。移植皮片覆盖的肌肉均无明显的皮肤感觉。对这些患者进行的详细步态分析证实了带皮片的游离肌皮瓣的负重能力，并且已被证明是评估足部重建的一种极佳方法。从这项研究来看，足部负重面的成功重建可能并不需要皮肤感觉。当局部组织不适合足底重建时，应考虑这种重建方法。
