Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Injury. 2023 Aug;54(8):110826. doi: 10.1016/j.injury.2023.05.057. Epub 2023 May 22.
Patients with heel pad degloving injury frequently develop ischemic necrosis of the area, necessitating soft-tissue reconstruction surgery. We have developed a technique for arterialization of the plantar venous system via vein graft (APV) as the primary revascularization treatment. The objective of this study was to clarify both the utility of APV for the preservation of degloved heel pads and the impact of this preservation on clinical outcomes.
Ten consecutive cases of degloving injury with devascularized heel pad were treated at a single trauma center from 2008 to 2018. Five cases underwent APV and five underwent conventional primary suture (PS) as the initial treatment. We evaluated the course according to the frequency of heel pad preservation, additional intervention after heel pad necrosis, post-operative complications, and outcomes using the Foot and Ankle Disability Index score (FADI) at the time of last follow-up.
Among the five cases that underwent APV, the heel pad was preserved in three cases and flap surgery was required in two cases. All cases that underwent PS developed necrosis of the heel pad, requiring skin graft in one case and flap surgery in four. One skin graft case and one free flap case after PS developed plantar ulcers. The three cases with preserved heel pads exhibited higher FADI than the seven cases that developed necrosis.
APV showed a relatively high frequency of heel pad preservation, which otherwise was uniformly lacking. Functional outcomes were improved in cases with preserved heel pad compared to those that developed necrosis and underwent additional tissue reconstruction.
足跟套脱伤患者常发生该区域的缺血性坏死，需要进行软组织重建手术。我们已经开发出一种通过静脉移植物（APV）动脉化足底静脉系统的技术，作为主要的血运重建治疗方法。本研究的目的是阐明 APV 对保留套脱足跟的有效性，以及这种保留对临床结果的影响。
2008 年至 2018 年，在一家创伤中心连续治疗了 10 例有去血管化足跟套脱伤的患者。5 例行 APV，5 例行常规初次缝合（PS）作为初始治疗。我们根据足跟垫的保留频率、足跟垫坏死后的附加干预、术后并发症以及最后一次随访时的足部和踝部残疾指数评分（FADI）来评估结果。
在 5 例行 APV 的病例中，有 3 例足跟垫保留，2 例需要皮瓣手术。所有行 PS 的病例均发生足跟垫坏死，1 例行皮片移植，4 例行皮瓣手术。PS 后 1 例皮片移植和 1 例游离皮瓣出现足底溃疡。保留足跟垫的 3 例的 FADI 高于发生坏死并进行额外组织重建的 7 例。
APV 显示出相对较高的足跟垫保留频率，而 PS 则完全缺乏。与发生坏死并进行额外组织重建的病例相比，保留足跟垫的病例功能结果有所改善。
