Khan Manal M, Cheruvu Ved Prakash Rao, Krishna Deepak, Laitonjam Michael, Minz Reena, Joshi Rishabh
Department of Burns and Plastic Surgery, All India Institute of Medical Sciences Bhopal, India.
Int J Burns Trauma. 2020 Aug 15;10(4):137-145. eCollection 2020.
Post-traumatic wounds over the dorsum of the foot are commonly seen in our practice. Road traffic accidents, crush injuries due to the fall of heavy objects and burns are common causes of these injures. The subcutaneous tissue in this region is very thin, and the tendons and bone are frequently exposed in these wounds. Since the skin is loosely attached to the underlying tendons, ligaments, and bones, the skin of the dorsum of the foot is also vulnerable to avulsion trauma. Added to this, there is a paucity of local tissues for coverage. Hence the management of these wounds is quite challenging. Through this article, we intend to describe our experience with traumatic dorsal foot wounds. A total of 33 patients were eligible according to the inclusion criteria and their details were included in the final analysis. There were 26 (78.79%) males and 7 (21.21%) females, with a male to female ratio of 3.71:1. The age of the study patients ranged from 8 to 62 years, with a mean age and standard deviation of 34.39 and 13.566 respectively. Majority of the study patients were in the 21-30 years age group (n=10, 30.3%). Road traffic accidents were the most common cause of traumatic dorsal foot wounds (n=20, 60.61%). Majority of the wounds showed features suggestive of infection (n=22, 66.67%) at presentation. Most of the patients in our study needed surgical intervention, in addition to medical management (n=28, 84.84%). Surgical procedures performed include split-thickness skin grafts, local flaps and free flaps. Early complications occurred in 5 (15.15%) patients and late complications in 2 (6.06%) patients. In conclusion, post-traumatic wounds of the dorsum of the foot are very common and pose a difficult reconstructive challenge. Skin grafts, local tissue flaps and free flap options are available for reconstruction; selection of the appropriate option should be individualized in a given patient. Local or distant flaps should be preferred in comparison to skin grafts, because of their long term durability and lesser chances of contractures. Reconstruction must consider form, function, and aesthetics.
在我们的临床实践中，足背的创伤后伤口很常见。道路交通事故、重物坠落导致的挤压伤和烧伤是这些损伤的常见原因。该区域的皮下组织非常薄，肌腱和骨骼在这些伤口中经常暴露。由于皮肤与下方的肌腱、韧带和骨骼附着松散，足背皮肤也容易受到撕脱伤。此外，用于覆盖的局部组织匮乏。因此，这些伤口的处理颇具挑战性。通过本文，我们打算描述我们处理创伤性足背伤口的经验。根据纳入标准，共有33例患者符合条件，其详细信息被纳入最终分析。男性26例（78.79%），女性7例（21.21%），男女比例为3.71:1。研究患者的年龄在8至62岁之间，平均年龄和标准差分别为34.39岁和13.566岁。大多数研究患者年龄在21 - 30岁组（n = 10，30.3%）。道路交通事故是创伤性足背伤口最常见的原因（n = 20，60.61%）。大多数伤口在就诊时表现出提示感染的特征（n = 22，66.67%）。我们研究中的大多数患者除了药物治疗外还需要手术干预（n = 28，84.84%）。所进行的手术包括断层皮片移植、局部皮瓣和游离皮瓣。5例（15.15%）患者发生早期并发症，2例（6.06%）患者发生晚期并发症。总之，足背创伤后伤口非常常见，给重建带来了困难的挑战。皮肤移植、局部组织皮瓣和游离皮瓣可供选择用于重建；在特定患者中应根据个体情况选择合适的方案。与皮肤移植相比，应优先选择局部或远处皮瓣，因为它们具有长期耐用性且挛缩几率较小。重建必须考虑形态、功能和美观。
