Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital, Central South University.
Department of general surgery, Xiangya Hospital, Central South University.
Injury. 2022 Jun;53(6):2333-2339. doi: 10.1016/j.injury.2022.02.015. Epub 2022 Feb 10.
To maximize the morpho-functional recovery on the totally degloved foot while not excessively introducing the technical complexity of microsurgery, we present a regionalized reconstruction, in which the highly functional subunit (weight-bearing area and ankle-around area) is covered by free skin flaps, and the less functional subunit (dorsum) by skin graft.
From June 2011 to December 2017, 10 patients who had total degloving injury on foot underwent reconstruction based on regionalized coverage. As the shape of combined flaps resemble a boat sock in high-heeled shoe, we name it as "Boat Sock" flaps. Complication like vascular compromise, partial or total flap loss, Equinus deformity and delayed plantar ulceration were documented elaborately. Secondary surgeries were also recorded. Foot function was evaluated by Maryland foot score at the last follow up.
Twenty-one free skin flaps were used for "Boat sock" coverage on highly functional subunits. Flap dimension ranged from 19×5cm to 28×8cm (mean 151cm). Among these flaps, one experienced partial necrosis which was treated conservatively, one experienced burn due to lack of protective sensation. Complication like Equinus deformity or delayed plantar ulceration did not occur. Secondary surgery included debulking on two cases. Mean Maryland foot score was 90.4.
This regionalized coverage by "Boat Sock" flaps and skin graft could serve as a standard procedure for reconstruction of the totally degloved foot, by offering the benefits of multi-plane coverage, a well-contoured ankle, an abrasion-tolerant planta, and eclectic surgical complexities.
为了在完全脱套伤的脚上实现形态和功能的最大恢复，同时又不过度增加显微外科的技术复杂性，我们提出了一种区域性重建方法，其中高功能亚单位（承重区和踝关节周围区）由游离皮瓣覆盖，低功能亚单位（背侧）由皮片覆盖。
自 2011 年 6 月至 2017 年 12 月，10 例足部完全脱套伤患者接受了基于区域性覆盖的重建。由于组合皮瓣的形状类似于高跟鞋上的船袜，我们将其命名为“船袜”皮瓣。详细记录了血管危象、部分或全部皮瓣坏死、马蹄内翻畸形和延迟性足底溃疡等并发症。也记录了二期手术。末次随访时采用 Maryland 足部评分评估足部功能。
21 个游离皮瓣用于高功能亚单位的“船袜”覆盖。皮瓣大小从 19×5cm 到 28×8cm（平均 151cm）。其中 1 例出现部分坏死，经保守治疗后治愈，1 例因缺乏保护感觉而烧伤。未发生马蹄内翻畸形或延迟性足底溃疡等并发症。二期手术包括 2 例削薄术。平均 Maryland 足部评分为 90.4 分。
“船袜”皮瓣和皮片的这种区域性覆盖可为完全脱套伤的重建提供多层面覆盖、轮廓良好的踝关节、耐磨的足底和多种手术复杂性的优势，可作为一种标准方法。
