Gjorup Caroline Asirvatham, Andersen Peter Stemann
Department of Plastic Surgery, Copenhagen University Hospital, Herlev and Gentofte Hospital, Denmark.
Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Denmark.
JPRAS Open. 2022 Mar 8;32:178-181. doi: 10.1016/j.jpra.2022.02.009. eCollection 2022 Jun.
Plantar defects are difficult to manage due to several reasons. The challenges of plantar reconstructions include lack of abundant local tissue, the requirement of the skin to be sensate, as well as the mechanical demand of the reconstruction to be able to withstand shearing forces and weight-bearing. Although rare, these defects are encountered following infections, trauma, and burns in addition to surgical oncological resections.
This case report describes the management of a plantar defect, measuring 45 × 55 mm, after surgical resection of a melanoma on the weight-bearing heel. The defect was managed with negative pressure wound therapy (NPWT) for 4 weeks, until granulation tissue was flush with the surrounding skin. Conservative treatment with wound care was conducted for another 12 weeks, until the wound, at 16 weeks, was completely healed. The patient tolerated the lengthy time of healing well and experienced no problems with the scar, and the functional and aesthetic outcome of conservative treatment of the plantar defect was excellent.
Healing by secondary intention is an excellent treatment option for the closure of large plantar defects, despite often being an overlooked reconstructive option.
足底缺损因多种原因难以处理。足底重建面临的挑战包括局部组织不丰富、重建后的皮肤需要具备感觉功能，以及重建需要能够承受剪切力和负重的力学要求。除了外科肿瘤切除术后，这些缺损在感染、创伤和烧伤后也较为罕见。
本病例报告描述了一例足底缺损的处理情况，该缺损位于负重足跟部，在手术切除黑色素瘤后大小为45×55毫米。缺损采用负压伤口治疗（NPWT）4周，直至肉芽组织与周围皮肤齐平。伤口护理保守治疗又持续了12周，直至伤口在16周时完全愈合。患者很好地耐受了较长的愈合时间，瘢痕未出现问题，足底缺损保守治疗的功能和美学效果极佳。
二期愈合是闭合大型足底缺损的一种极佳治疗选择，尽管它常常是一种被忽视的重建选择。
