Han Yan, Han Yudi, Song Baoqiang, Guo Lingli, Tao Ran, Chai Mi
From the Department of Plastic and Reconstructive Surgery, First Medical Center of PLA General Hospital.
Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, People's Republic of China.
Ann Plast Surg. 2020 May;84(5S Suppl 3):S178-S185. doi: 10.1097/SAP.0000000000002373.
Trauma can cause large defects in the weight-bearing foot sole. The reconstruction of such defects poses a major challenge in providing a flap that is durable, sensate, and stable. The pedicled medial plantar flap has been commonly used for reconstructing heel and plantar forefoot defects; however, the ipsilateral instep region is usually compromised by trauma. The purpose of this article was to report the use of contralateral free medial plantar flaps for the coverage of weight-bearing plantar defects and to compare these with distant free flaps.
Between 2005 and 2019, 15 patients (10 men and 5 women) with weight-bearing foot plantar defects were treated with a contralateral medial plantar flap, 11 (7 men and 4 women) with either a latissimus dorsi flap or a scapular flap. The average age was 18.07 ± 10.14 years (range, 4-34 years) and 26.55 ± 13.05 years (range, 13-56 years), respectively. Surgery was performed as a primary or secondary reconstruction after a trauma by the same surgical team.
The mean size of defects was 9.73 ± 3.55 × 6.43 ± 2.8 cm in the contralateral free medial plantar flap group and 17.14 ± 6.84 × 11.41 ± 4.29 cm in the free dorsal flap group. All flaps survived in both groups. In the instep flap group, the appearance was satisfactory, the flap was durable, and tactile sensation was preserved in all patients, and none required a revision procedure. Two patients experienced delayed union of the donor-site grafted skin. In the dorsal flap group, 5 patients complained of a partial necrosis or delayed union at the recipient site, and 9 developed recurrent ulcerations over the weight-\bearing area. Five patients achieved only partial sensation in the flap.
The contralateral medial plantar flap provides superior appearance, duration, and sensation over distant muscle flaps, without recurrent ulcerations. However, dorsal myocutaneous flaps may be used as a substitute when the defects are beyond the maximum boundaries of the instep area or are combined with bone loss.
创伤可导致负重足底出现大面积缺损。此类缺损的重建对提供耐用、有感觉且稳定的皮瓣构成了重大挑战。带蒂内侧足底皮瓣常用于重建足跟和足底前足缺损；然而，同侧脚背区域通常也会受到创伤影响。本文旨在报告使用对侧游离内侧足底皮瓣覆盖负重足底缺损的情况，并将其与远位游离皮瓣进行比较。
2005年至2019年间，15例（10例男性，5例女性）负重足底缺损患者接受了对侧内侧足底皮瓣治疗，11例（7例男性，4例女性）接受了背阔肌皮瓣或肩胛皮瓣治疗。平均年龄分别为18.07±10.14岁（范围4 - 34岁）和26.55±13.05岁（范围13 - 56岁）。手术由同一手术团队在创伤后进行一期或二期重建。
对侧游离内侧足底皮瓣组缺损的平均大小为9.73±3.55×6.43±2.8 cm，游离背侧皮瓣组为17.14±6.84×11.41±4.29 cm。两组皮瓣均全部存活。在脚背皮瓣组中，外观满意，皮瓣耐用，所有患者的触觉均得以保留，且无一例需要进行修复手术。2例患者供区植皮出现延迟愈合。在背侧皮瓣组中，5例患者抱怨受区出现部分坏死或延迟愈合，9例患者在负重区出现复发性溃疡。5例患者皮瓣仅获得部分感觉。
对侧内侧足底皮瓣在外观、耐用性和感觉方面优于远位肌皮瓣，且无复发性溃疡。然而，当缺损超出脚背区域的最大边界或合并骨质缺损时，背侧肌皮瓣可作为替代选择。
