Singer D I, Morrison W A, McCann J J, Renney J T
Microsurgery Research Centre, St Vincent's Hospital, Fitzroy, Victoria.
Aust N Z J Surg. 1988 Oct;58(10):817-23. doi: 10.1111/j.1445-2197.1988.tb00986.x.
Four patients with five severely traumatized lower legs but preserved feet were treated with fillet flaps from the foot to cover an elective, below knee amputation stump. The posterior tibial neurovascular bundle nourished and innervated this flap. While the posterior tibial artery and vein may be cut and re-anastomosed to prevent kinking and occlusion, the posterior tibial nerve should always be kept in continuity to maintain the quality of sensation to this flap. Four flaps survived and one necrosed secondary to venous insufficiency. Due to its innervation and the unique qualities of heel skin, the flap is very durable and has endweight-bearing capabilities. This has permitted the fitting of an endweight-bearing, total contact, fully extended, below knee prosthesis that appears to offer significant improvement in ease of use and normality of gait pattern over standard patellar tendon-bearing prostheses.
4例患者有5条小腿严重创伤但足部保留，采用足部的鱼际皮瓣覆盖择期的膝下截肢残端。胫后神经血管束滋养并支配该皮瓣。虽然胫后动脉和静脉可切断并重新吻合以防止扭结和阻塞，但胫后神经应始终保持连续性以维持该皮瓣的感觉质量。4个皮瓣存活，1个因静脉功能不全坏死。由于其神经支配以及足跟皮肤的独特特性，该皮瓣非常耐用且具有末端负重能力。这使得能够安装一种末端负重、全接触、完全伸展的膝下假肢，与标准髌腱承重假肢相比，在易用性和步态模式的正常性方面似乎有显著改善。
