Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, South Korea.
Injury. 2021 Jul;52(7):1993-1998. doi: 10.1016/j.injury.2021.04.007. Epub 2021 Apr 7.
The reverse sural artery flap (RSAF) is widely used to reconstruct foot and ankle defects. Although it is commonly used in a nonsensate type, there has been controversy as to whether it provides sufficient stability and durability when applied to weight-bearing heels. The aim of this study was to evaluate patient outcomes after weight-bearing heel coverage using a nonsensate RSAF.
Twenty-three patients who underwent reconstruction surgery of the weight-bearing heel with RSAF from 2004 to 2018 in a tertiary hospital were retrospectively reviewed. All surgeries were performed without a sensate procedure. The patients' experience of pressure sore on the flap area and the ability to use normal footwear were investigated. Light touch, Semmes-Weinstein test (SWT), and two-point discrimination tests were assessed, along with postoperative wound complications.
Heel damage etiologies included malignant tumors in 14 (61%), trauma-related in 7 (30%) and diabetic ulcers in 2 (9%) patients. Patient mean age was 58 years (range, 18-93 years) and the mean follow-up period was 57 months (range, 12-185 months). The mean size of the flap was 64.1 cm2 (range, 20-169 cm). All flaps healed without major complications. All returned to daily living activities and 20 (86%) patients were able to use normal footwear. Of the 11 patients who had available measurement records, 8 (73%) showed a light touch sense. The mean SWT value was 4.31 (range, 3.61- 4.56). Two-point discrimination was not observed in any of the patients. Two patients had experienced superficial ulcers on the flap within a one-year postoperative period, which spontaneously healed and did not recur. No full-thickness ulcers were observed during the follow-up period.
The results of this study suggest that patients who underwent nonsensate RSAF for the reconstruction of the heel could expect to maintain the property for stable weight-bearing without pressure sore.
逆行腓动脉皮瓣（RSAF）广泛用于足部和踝关节缺损的重建。虽然它通常用于非感觉型，但在应用于承重跟部时，它是否能提供足够的稳定性和耐久性一直存在争议。本研究旨在评估使用非感觉型 RSAF 覆盖承重跟部后的患者结果。
回顾性分析 2004 年至 2018 年在一家三级医院接受 RSAF 重建手术的 23 例承重跟部患者的资料。所有手术均未行感觉重建。调查了皮瓣区域压疮的发生情况和使用正常鞋的能力。评估轻触觉、Semmes-Weinstein 试验（SWT）和两点辨别试验，以及术后伤口并发症。
跟部损伤的病因包括恶性肿瘤 14 例（61%）、创伤相关 7 例（30%）和糖尿病溃疡 2 例（9%）。患者平均年龄为 58 岁（18-93 岁），平均随访时间为 57 个月（12-185 个月）。皮瓣平均大小为 64.1cm2（20-169cm）。所有皮瓣均无主要并发症愈合。所有患者均恢复日常生活活动，20 例（86%）患者能够使用正常鞋。11 例可获得测量记录的患者中，8 例（73%）有轻触觉。SWT 值的平均值为 4.31（3.61-4.56）。所有患者均未观察到两点辨别觉。2 例患者术后 1 年内皮瓣出现浅表溃疡，自行愈合且未复发。随访期间无全层溃疡。
本研究结果表明，接受非感觉型 RSAF 重建跟部的患者可以预期在不发生压疮的情况下保持稳定承重的功能。
