Opoku-Agyeman Jude L, Allen Amber, Humenansky Kayla
Plastic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.
Foot and Ankle Surgery, Private practice, Philadelphia, USA.
Cureus. 2020 Aug 19;12(8):e9880. doi: 10.7759/cureus.9880.
Soft tissue reconstruction of the heel represents a daunting challenge for reconstructive surgeons, given the weight-bearing role and anatomical properties of the glabrous skin on the plantar surface. For soft tissue defects in this area, the medial plantar artery (MPA) flap has been described as an optimal reconstructive option. Many studies have reported on the use of the medial plantar artery flap for soft tissue coverage of the heel. There currently exists no systematic review on the topic.
The aim of this article is to review the literature on the use of local medial plantar artery flap for heel reconstruction with a focus on overall flap viability and selected outcomes.
The authors performed a systematic literature review using EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, PubMed database, and grey literature. Studies were identified between 1981 and 2019. Peer-reviewed articles published in the English language were included. Articles were eligible if they contained original clinical outcomes on patients who underwent local medial plantar artery flap for reconstruction of heel defects.
A total of 135 unique studies were identified. Eighteen (18) articles were included in the review and analyses, yielding a total of 277 local medial plantar artery flaps for heel coverage. The most common etiology for the reconstructed heel defect was ulcers (45.3%) followed by trauma (35.8%). The overall complete flap survival rate was n=272/277 (98.2%). The incidence of minor flap complication was n=26/277 (9.4%). Most of the flaps maintained protective sensation (n=147/148 [99.3%]), although the protective sensation tended to be inferior to the contralateral normal side. The rate of donor site morbidity was n=14/269 (5.2%).
Local medial plantar artery flap for heel defect reconstruction is associated with a very high flap survival rate with very few flap related complications including donor site complications.
由于足底无毛皮肤的负重作用和解剖特性，足跟软组织重建对重建外科医生来说是一项艰巨的挑战。对于该区域的软组织缺损，内侧足底动脉（MPA）皮瓣已被描述为一种理想的重建选择。许多研究报道了内侧足底动脉皮瓣用于足跟软组织覆盖。目前尚无关于该主题的系统评价。
本文旨在综述关于使用局部内侧足底动脉皮瓣进行足跟重建的文献，重点关注皮瓣的整体存活率和选定的结果。
作者使用EMBASE、Cochrane图书馆、Ovid医学、MEDLINE、谷歌学术、PubMed数据库和灰色文献进行了系统的文献综述。研究时间范围为1981年至2019年。纳入以英文发表的同行评审文章。如果文章包含接受局部内侧足底动脉皮瓣重建足跟缺损患者的原始临床结果，则符合纳入标准。
共识别出135项独特研究。18篇文章被纳入综述和分析，共277个用于足跟覆盖的局部内侧足底动脉皮瓣。重建足跟缺损最常见的病因是溃疡（45.3%），其次是创伤（35.8%）。皮瓣总体完全存活率为n = 272/277（98.2%）。轻微皮瓣并发症发生率为n = 26/277（9.4%）。大多数皮瓣保留了保护性感觉（n = 147/148 [99.3%]），尽管保护性感觉往往低于对侧正常侧。供区发病率为n = 14/269（5.2%）。
用于足跟缺损重建的局部内侧足底动脉皮瓣具有非常高的皮瓣存活率，皮瓣相关并发症（包括供区并发症）极少。
