Feng Bo, Dai Guang-Ming, Wang Yong-Jun, Zhang Lan, Niu Ke-Cheng
Department of Foot and Ankle Surgery, The Third Affiliated Hospital of Inner Mongolia Medical University, Baotou, 014010, People's Republic of China.
Int J Gen Med. 2021 Nov 18;14:8445-8453. doi: 10.2147/IJGM.S329642. eCollection 2021.
To summarize the clinical application effects of three different types of flaps for repairing soft tissue defects of the heel, and to discuss the importance of tissue repair and heel reconstruction.
A total of 46 cases with skin tissue defects of the heel with deep tissue exposure were treated. The reasons for the defect were trauma (n = 26), burns and electric shocks (n = 12), chronic ulcers (n = 2), postoperative infection of the calcaneus and Achilles tendon (n = 5), and tumor resection (n = 1). The scope of wound defect was 2.0×2.5 to approximately 15.0×20.0 cm. The flaps used were medial plantar island flaps (n = 9), distal pedicled sural neurovascular island flaps (n = 23), and free anterolateral thigh (perforator) flaps (n = 14). The flap cutting range was 3.0×3.5 to approximately 16.0×22.0 cm.
After surgery, all 46 flaps survived. In two cases, patients experienced partial epidermal necrosis at the distal end of the flap that healed after local dressing exchange, and after this treatment, the complete skin grafts survived. Follow-up was conducted in 40 cases, with an average follow-up duration of 8.2 months (3-44 months) and the two-point discrimination of 5-14 mm. The average American Orthopaedic Foot and Ankle Society scale was 89.2 points with good flap color and texture, satisfactory appearance, and normal gait.
The repair method should be selected according to the"5-zone method": The plantar medial island flap is suitable for small area (<5 cm) of medial, posterior and plantar defects. The distal pedicled sural neurovascular flap is suitable for lateral, posterior, and medium-range (6-10 cm) joint area defects. The free anterolateral thigh perforator flap is suitable for large-scale (>10 cm) joint area defects.
总结三种不同类型皮瓣修复足跟软组织缺损的临床应用效果，探讨组织修复与足跟重建的重要性。
共治疗46例足跟皮肤组织缺损且深部组织外露的患者。缺损原因包括创伤（26例）、烧伤与电击伤（12例）、慢性溃疡（2例）、跟骨及跟腱术后感染（5例）、肿瘤切除（1例）。伤口缺损范围为2.0×2.5至约15.0×20.0厘米。使用的皮瓣包括足底内侧岛状皮瓣（9例）、带蒂腓肠神经营养血管远端岛状皮瓣（23例）、游离股前外侧（穿支）皮瓣（14例）。皮瓣切取范围为3.0×3.5至约16.0×22.0厘米。
术后46例皮瓣全部成活。2例患者皮瓣远端出现部分表皮坏死，经局部换药后愈合，经此处理后全厚皮片成活。对40例患者进行随访，平均随访时间为8.2个月（3至44个月），两点辨别觉为5至14毫米。美国矫形足踝协会平均评分为89.2分，皮瓣颜色和质地良好，外观满意，步态正常。
应根据“五分区法”选择修复方法：足底内侧岛状皮瓣适用于内侧、后侧及足底小面积（<5厘米）缺损；带蒂腓肠神经营养血管远端皮瓣适用于外侧、后侧及中范围（6至10厘米）关节区缺损；游离股前外侧穿支皮瓣适用于大面积（>10厘米）关节区缺损。
