Alfonso Allyson R, Mayo James L, Sharma Vishal K, Allen Robert J, Chiu Ernest S
In New York, New York, Allyson R. Alfonso, BS, BA, is a Medical Student, New York University School of Medicine; James L. Mayo, MD, and Vishal K. Sharma, MD, FRCSC, are Microsurgery Fellows, Institute of Reconstructive Plastic Surgery, NYU Langone Health; Robert J. Allen, Sr, MD, is a Clinical Professor, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health; and Ernest S. Chiu, MD, FACS, is Associate Professor of Plastic Surgery, Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health. The authors have disclosed no financial relationships related to this article. Submitted June 21, 2016; accepted in revised form November 14, 2016.
Adv Skin Wound Care. 2018 Feb;31(2):78-81. doi: 10.1097/01.ASW.0000527289.73958.4c.
Plantar foot reconstruction requires special consideration of both form and function. There are several fasciocutaneous flap options, each with indications and reservations.
This case presents a new application of the vertical profunda artery perforator flap for definitive closure of a neuropathic foot ulcer in a young woman with spina bifida. The postoperative course was uneventful, and the flap survived completely. The surgical and donor sites were without wound recurrence at 5-month follow-up.
Understanding the variability of foot flap options is important because of unique cases such as the one presented where the wound was caused by specific and less commonly observed foot anatomy. The specific choice to use the vertical profunda artery perforator flap for this patient and her neuropathic wound type was made based on its excellent flexibility, durability, and donor site appeal.
The vertical profunda artery perforator flap has adequate surface area and bulk and a favorable pedicle length and caliber, can be thinned, and leaves a donor scar in a less conspicuous area than other popular free flaps for lower-extremity reconstruction. For these reasons, it should be considered a first-line therapy for free flap coverage of selected foot wounds.
足底重建需要对形态和功能进行特殊考虑。有几种筋膜皮瓣可供选择，每种都有其适应证和局限性。
本病例展示了垂直股深动脉穿支皮瓣在一名患有脊柱裂的年轻女性神经性足部溃疡确定性闭合中的新应用。术后过程顺利，皮瓣完全存活。在5个月的随访中，手术部位和供区均无伤口复发。
了解足部皮瓣选择的变异性很重要，因为存在一些独特的病例，如本病例中伤口是由特定且较少见的足部解剖结构引起的。针对该患者及其神经性伤口类型选择使用垂直股深动脉穿支皮瓣，是基于其出色的灵活性、耐用性和供区美观性。
垂直股深动脉穿支皮瓣具有足够的表面积和厚度，蒂长度和管径适宜，可进行修薄，且与其他用于下肢重建的常用游离皮瓣相比，其供区瘢痕位于较不显眼的区域。基于这些原因，对于选定的足部伤口的游离皮瓣覆盖，应将其视为一线治疗方法。
