Khai Luen Koh, Wan Sulaiman Wan Azman
Plastic and Reconstructive Surgical Trainee, Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia.
Associate Professor and Consultant Plastic and Reconstructive Surgeon, Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kota Bharu, Malaysia.
J Foot Ankle Surg. 2017 Sep-Oct;56(5):1114-1120. doi: 10.1053/j.jfas.2017.04.024.
Sensate, durable heel pad reconstruction is challenging. The present study assessed the functional outcomes after heel pad reconstruction using various flap techniques at our institution. From June 2011 to June 2016 (5-year period), 7 consecutive patients underwent heel pad reconstruction for various etiologies, with 3 microvascular free flaps (42.9%; 2 musculocutaneous flaps [66.7%] and 1 contralateral medial plantar flap [33.3%]) and 4 local pedicle flaps (57.1%; 3 instep medial plantar artery flaps [75.0%] and 1 distally based reverse sural flap [25.0%]). The patient records and demographic data were reviewed, and surgically related information was obtained and analyzed. The subjective components of the American Orthopaedic Foot and Ankle Society hindfoot clinical ratings scale were used to evaluate the pain and functional outcomes. Sensation was assessed using Semmes-Weinstein monofilaments, and ulcer recurrence was recorded. The mean age of the patients was 41.7 (range 11 to 70) years, the mean defect size was 59 (range 12 to 270) cm, and the mean follow-up duration was 22 (range 15 to 43) months. Complete flap survival was achieved without significant complications in all 7 patients. Patients treated with the sensate medial plantar artery flap recorded the highest mean American Orthopaedic Foot and Ankle Society score of 57.3 (maximum score of 60) and experienced a return of deep sensation at 6 (range 6 to 24) months and protective sensation at 1 year. This was followed by the reverse sural flap and the musculocutaneous flap. No recurrent heel ulceration was observed in our series of patients. In conclusion, the sensate medial plantar flap is a satisfactory method for coverage of small- to moderate-size heel defects.
有感觉、持久的足跟垫重建具有挑战性。本研究评估了在我们机构使用各种皮瓣技术进行足跟垫重建后的功能结果。在2011年6月至2016年6月（5年期间），连续7例患者因各种病因接受了足跟垫重建，其中3例采用游离微血管皮瓣（42.9%；2例肌皮瓣[66.7%]和1例对侧内侧足底皮瓣[33.3%]），4例采用局部带蒂皮瓣（57.1%；3例足背内侧足底动脉皮瓣[75.0%]和1例远端蒂逆行腓肠皮瓣[25.0%]）。回顾了患者记录和人口统计学数据，并获取和分析了手术相关信息。采用美国矫形足踝协会后足临床评分量表的主观部分来评估疼痛和功能结果。使用Semmes-Weinstein单丝评估感觉，并记录溃疡复发情况。患者的平均年龄为41.7岁（范围11至70岁），平均缺损大小为59平方厘米（范围12至270平方厘米），平均随访时间为22个月（范围15至43个月）。所有7例患者均实现了皮瓣完全存活，无明显并发症。接受有感觉的内侧足底动脉皮瓣治疗的患者记录的美国矫形足踝协会平均评分最高，为57.3分（满分60分），在6个月（范围6至24个月）时恢复了深部感觉，1年后恢复了保护性感觉。其次是逆行腓肠皮瓣和肌皮瓣。在我们的患者系列中未观察到足跟溃疡复发。总之，有感觉的内侧足底皮瓣是覆盖中小尺寸足跟缺损的一种令人满意的方法。
