Löfstrand Jonas Gustafsson, Lin Chih-Hung
Ann Plast Surg. 2018 Mar;80(3):245-251. doi: 10.1097/SAP.0000000000001274.
Defects in the weight-bearing heel or forefoot are commonly derived from chronic wounds, acute trauma, or tumor excision. Reconstruction of such defects pose a significant challenge to provide a flap that is stable, durable, and sensate. Several flaps have been described for reconstruction of plantar defects, but recurrent ulcerations and/or the need of additional procedures are common. This article provides the approach and outcomes of innervated free medial plantar flap for weight-bearing plantar defects reconstruction.
Chart review was performed of 17 consecutive patients with defects in the weight-bearing heel and/or forefoot who were treated with innervated free medial plantar flaps between the years 1999 and 2016. Eleven patients were male, and 6 patients were female. The mean age was 29.5 years (range, 4-52 years). One case was combined heel/forefoot defect, 7 were heel defects, and 9 were forefoot defects. Indications were acute trauma, secondary reconstruction after trauma, and tumor excision.
The mean defect size was 8.0 ± 5.4 cm × 5.1 ± 2.1 cm, and mean flap size was 9.7 ± 1.4 cm × 6.4 ± 0.9 cm. One flap suffered from arterial thrombosis, which necessitated reoperation, and was salvaged. For the remaining cases, the postoperative course was uneventful. The mean follow-up time was 59.3 (±51.3.6) months. Two patients received minor flap corrections due to hyperkeratosis and hypertrophic scar, and 2 patients required donor site correction owing to partial loss of skin graft. One patient succumbed within 1 year owing to metastatic disease. All patients that were followed more than 1 year (n = 15) could sense blunt touch of the flap. Ten patients underwent 2-point discrimination test. No patient had recurrence of ulceration.
The innervated medial plantar flap is an excellent solution for treatment of medium-to-large defects in the weight-bearing heel or forefoot. It provides glabrous skin that is stable, durable, and sensate. The long-term results are good, with no patient afflicted by recurrent ulceration during the follow-up time.
负重足跟或前足缺损通常源于慢性伤口、急性创伤或肿瘤切除。重建此类缺损对提供稳定、耐用且有感觉功能的皮瓣构成重大挑战。已有多种皮瓣被描述用于足底缺损的重建，但复发性溃疡和/或需要额外手术的情况很常见。本文介绍了带神经的游离内侧足底皮瓣用于负重性足底缺损重建的方法及结果。
对1999年至2016年间连续17例接受带神经游离内侧足底皮瓣治疗的负重足跟和/或前足缺损患者的病历进行回顾。11例为男性，6例为女性。平均年龄29.5岁（范围4 - 52岁）。1例为足跟/前足联合缺损，7例为足跟缺损，9例为前足缺损。适应证为急性创伤、创伤后二期重建及肿瘤切除。
平均缺损大小为8.0±5.4 cm×5.1±2.1 cm，平均皮瓣大小为9.7±1.4 cm×6.4±0.9 cm。1例皮瓣发生动脉血栓形成，需再次手术并成功挽救。其余病例术后过程顺利。平均随访时间为59.3（±51.36）个月。2例患者因角化过度和肥厚性瘢痕接受了小的皮瓣修整，2例患者因植皮部分丢失需要供区修整。1例患者因转移性疾病在1年内死亡。所有随访超过1年的患者（n = 15）均能感觉到皮瓣的钝性触觉。10例患者进行了两点辨别试验。无患者发生溃疡复发。
带神经的内侧足底皮瓣是治疗负重足跟或前足中到大缺损的极佳解决方案。它提供无毛皮肤，稳定、耐用且有感觉功能。长期效果良好，随访期间无患者出现溃疡复发。
