From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine.
Plast Reconstr Surg. 2019 Apr;143(4):1223-1244. doi: 10.1097/PRS.0000000000005448.
Reconstruction of the plantar surface of the foot is challenging because of its distinctive anatomy and microarchitecture. Unfortunately, no single coverage option meets the needs of all patients and defects. A comprehensive literature review is presented to better define available reconstructive options for resurfacing the plantar foot.
A systematic literature search was performed to identify articles relating to reconstruction of the plantar skin and soft tissue. The PubMed, Embase, and Scopus databases were queried for published articles. After the exclusion of duplicate records, 1624 articles were available for review. A total of 280 unique articles were included for analysis, with a total of 2684 individual reconstructions.
Of the articles reviewed, 10 percent described a skin grafting technique, 53 percent described a locoregional flap, 32 percent described free tissue transfer, and 5 percent described multiple reconstructive methods. Isolated heel defects were the most frequently reconstructed subunit of the plantar foot (73 percent). The latissimus dorsi muscle was the most commonly used free flap, whereas the reverse sural artery flap was the most commonly used locoregional flap. Protective sensation was noted in most locoregional and free flap reconstructions, regardless of primary neurotization; however, improved two-point discrimination was noted when neurofasciocutaneous flaps were used. Complication rates varied widely, although rates of flap loss approached those of flaps performed at other anatomical sites.
Numerous methods exist for reconstructing the plantar surface. Proper flap selection should be determined by the size of the defect, the availability of donor tissue, and the surgeon's experience and comfort with the reconstructive technique.
由于足部具有独特的解剖结构和微观结构，因此对其进行重建极具挑战性。不幸的是，没有任何单一的覆盖物能够满足所有患者和缺陷的需求。本文对现有文献进行了综述，以更好地定义用于覆盖足底的重建选择。
系统地检索了与足底皮肤和软组织重建相关的文献。在 PubMed、Embase 和 Scopus 数据库中查询已发表的文章。排除重复记录后，有 1624 篇文章可供审查。共有 280 篇独特的文章被纳入分析，共有 2684 例单独的重建。
在回顾的文章中，10%描述了植皮技术，53%描述了局部皮瓣，32%描述了游离组织转移，5%描述了多种重建方法。孤立的足跟缺陷是足底最常重建的亚单位（73%）。背阔肌是最常用的游离皮瓣，而逆行腓动脉皮瓣是最常用的局部皮瓣。无论是否进行了原发性神经化，大多数局部皮瓣和游离皮瓣重建都能感觉到保护性感觉，但使用神经皮血管皮瓣时，两点辨别力有所提高。并发症发生率差异很大，但皮瓣丢失率与在其他解剖部位进行的皮瓣相似。
有许多方法可用于重建足底表面。适当的皮瓣选择应根据缺陷的大小、供区组织的可用性以及外科医生对重建技术的经验和舒适度来确定。
