Kachare Swapnil D, Vivace Bradley J, Henderson Joshua T, Kachare Milind, Kapsalis Christina, Fulfer Jamie L, Choo Joshua, Wilhelmi Bradon J
Division of Plastic and Reconstructive Surgery, Department of Surgery.
School of Medicine, University of Louisville, Louisville, KY.
Eplasty. 2019 Apr 9;19:e11. eCollection 2019.
Management of calcaneal wounds is challenging due to a paucity of tissue, complex local anatomy, and limited vascularity. These wounds are commonly associated with lower extremity fractures, which are often treated with external fixation. Free tissue transfers are frequently employed as a means for closure of plantar heel wounds; however, postoperative management can be challenging due to their dependent location. We sought to describe how simple modification of the external fixator can help relieve direct pressure, provide joint immobilization, and optimize accessibility necessary for flap survival. Three patients requiring autologous free tissue reconstruction of hindfoot defects were immobilized using an external fixator with a "kickstand" modification. Viability of the transferred tissue and the postoperative outcomes were assessed. All free flaps survived with no associated complications. The "kickstand" modification was well tolerated with minimal discomfort. All 3 patients expressed satisfaction with early return to ambulation. An external fixator with a "kickstand" modification provides an essential function in maintaining the viability of the transferred tissue to plantar calcaneal wounds.
由于组织稀少、局部解剖结构复杂以及血运有限，跟骨伤口的处理颇具挑战性。这些伤口通常与下肢骨折相关，下肢骨折常采用外固定治疗。游离组织移植常用于闭合足跟足底伤口；然而，由于其位置低垂，术后管理可能具有挑战性。我们试图描述如何对外固定器进行简单改良，以帮助减轻直接压力、提供关节固定，并优化皮瓣存活所需的可达性。3例需要自体游离组织重建后足缺损的患者使用改良“支架”的外固定器进行固定。评估移植组织的存活情况和术后结果。所有游离皮瓣均存活，无相关并发症。改良“支架”耐受性良好，不适轻微。所有3例患者对早期恢复行走均表示满意。改良“支架”的外固定器在维持移植到跟骨足底伤口的组织的存活方面发挥着重要作用。
