Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts.
J Reconstr Microsurg. 2020 Jan;36(1):32-40. doi: 10.1055/s-0039-1694734. Epub 2019 Aug 26.
Soft tissue reconstruction of the foot represents a complex reconstructive challenge given the unique anatomical properties of the glabrous plantar skin. For large soft tissue defects and/or complex injuries, free tissue transfer is often the optimal reconstructive modality. The decision to pursue a neurotized free flap remains controversial and an area of debate. Given the trend toward increasing use of neurotized free flaps, we performed a systematic review to determine if nerve coaptation is a beneficial adjunct to free tissue transfer.
A systematic search of the English literature using PubMed and Web of Science was performed. Studies were identified between 1985 and 2018. Manuscripts were eligible if they contained original clinical outcomes research of patients who underwent free tissue transfer to the foot or heel with neurotization.
A total of 189 studies were identified with initial screening and 19 studies were included in our analysis. A total of 175 patients underwent free flap reconstruction to the foot; of these, 107 patients had a nerve coaptation performed. Patients who underwent neurotization had improved sensory characteristics (two-point discrimination, light touch, and pain sensation), quicker return to ambulation and activities of daily living, and decreased ulcer formation compared with those who did not. Overall complications were infrequent, with ulceration being the most common.
Neurotized free flaps appear to have an overall decreased rate of ulceration, improved sensory discrimination, and quicker return to ambulation/activities of daily living in comparison to nonneurotized free flaps. However, when examining free anterolateral thigh (ALT) and free medial plantar artery (MPA) fasciocutaneous flaps, durability (i.e., frequency of ulcer formation) and functionality (ambulation and return to activities of daily living) do not appear to be significantly different between neurotized and nonneurotized flaps.
由于足底光滑的皮肤具有独特的解剖学特性，因此足部软组织重建是一项复杂的重建挑战。对于较大的软组织缺损和/或复杂损伤，游离组织转移通常是最佳的重建方式。选择进行神经营养游离皮瓣仍然存在争议，这也是一个争论的领域。鉴于神经化游离皮瓣的使用趋势不断增加，我们进行了系统评价，以确定神经吻合是否是游离组织转移的有益辅助手段。
使用 PubMed 和 Web of Science 对英文文献进行系统搜索。研究时间为 1985 年至 2018 年。如果包含接受足部或足跟神经化游离组织转移的患者的原始临床结果研究的手稿，则符合入选标准。
初步筛选后共确定了 189 项研究，其中 19 项研究纳入分析。共有 175 例患者接受游离皮瓣重建足部；其中 107 例患者进行了神经吻合。与未进行神经吻合的患者相比，接受神经化的患者具有更好的感觉特征（两点辨别觉、轻触觉和痛觉）、更快地恢复步行和日常生活活动以及减少溃疡形成。总体并发症发生率较低，溃疡是最常见的并发症。
与非神经化游离皮瓣相比，神经化游离皮瓣似乎总体上溃疡发生率较低，感觉辨别力提高，且恢复步行/日常生活活动的速度更快。然而，在检查游离前外侧股（ALT）和游离内侧足底动脉（MPA）筋膜皮瓣时，神经化和非神经化皮瓣的耐用性（即溃疡形成的频率）和功能（步行和恢复日常生活活动）似乎没有显著差异。
