Joseph M. Still Burn and Reconstructive Center, Jackson, MS.
From the Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Key Laboratory of Orthopedics of Zhejiang Province, Wenzhou.
Ann Plast Surg. 2021 Jun 1;86(6):668-673. doi: 10.1097/SAP.0000000000002811.
The purpose of this study was to compare the reconstructive outcomes of soft-tissue defects around foot and ankle with local or free flaps and attempt to provide an optimal strategy for these patients in comparison with the conventional guidelines.
A retrospective review of all continuous patients with foot and ankle reconstruction using different flaps from 2010 to 2018 was performed. Based on the flap types, the patients were divided into 2 groups: local flap group and free flap group. Outcomes were assessed according to the flap survival rate, recipient complications, aesthetic outcomes, and donor-site complications.
A total of 130 flaps including 47 free flaps and 83 local flaps were collected. There was no difference in flap survival rate between the 2 groups; however, a significant difference in aesthetic outcomes was noted between them: the free flap group presented a better overall aesthetic outcomes in comparison with the local flap group in terms of color and contour match. Moreover, local flaps had more donor-site morbidities including the need for skin grafting and wound infection.
Free flaps in wound coverage of foot and ankle can achieve better outcomes than local flaps in terms of recipient benefits and donor-site compromise with a comparable flap survival rate.
本研究旨在比较足部和踝关节周围软组织缺损采用局部皮瓣或游离皮瓣的重建效果，并尝试为这些患者提供一种与传统指南相比的最佳治疗策略。
对 2010 年至 2018 年间使用不同皮瓣进行足部和踝关节重建的所有连续性患者进行回顾性分析。根据皮瓣类型，将患者分为 2 组：局部皮瓣组和游离皮瓣组。根据皮瓣成活率、受区并发症、美学效果和供区并发症来评估结果。
共收集了 130 个皮瓣，其中 47 个为游离皮瓣，83 个为局部皮瓣。两组的皮瓣成活率无差异；然而，两组的美学效果存在显著差异：游离皮瓣组在颜色和轮廓匹配方面的整体美学效果明显优于局部皮瓣组。此外，局部皮瓣的供区并发症更多，包括需要植皮和感染。
游离皮瓣在足部和踝关节的创面覆盖中，在受区获益和供区并发症方面的效果优于局部皮瓣，且皮瓣成活率相当。
