Felder John M, Tawaklna Kenan, Said Abdullah M, Lohasammakul Suphalerk, Saraswat Nirvana B, Hong Joon Pio
From the Division of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University in St. Louis.
Plast Reconstr Surg. 2025 Aug 1;156(2):305e-309e. doi: 10.1097/PRS.0000000000011902. Epub 2024 Nov 26.
Optimal reconstruction of weight-bearing plantar foot defects is challenging due to the need for relatively thin coverage with simultaneous durability. The medial plantar flap provides an excellent tissue match but is not always available or appropriate. Microsurgical free-flap reconstruction provides many options for coverage. However, few skin flaps are thin enough to contour appropriately but still provide thick dermis for durable weight-bearing, particularly in patients with an average or obese body habitus. The back and buttocks provide the thickest skin in the body, but relatively little attention has been paid to use of these flaps in the foot. The suprascarpal plane of elevation has been increasingly used to provide tailored coverage with appropriate thickness matching to the surrounding tissues. Even thinner "ultrathin flaps" are raised within the subcutaneous fat superficial to the Scarpa layer. Little attention has been paid to applying this concept specifically to flaps from the back that provide thicker skin. The scapular and parascapular flaps have many ideal characteristics for foot reconstruction, including minimal donor-site morbidity, simple pedicle dissection, short pedicle for appropriate reach to nearby recipient vessels, and thick skin for durable weight-bearing. However, thus far, these flaps seem to have been overlooked as candidates for suprascarpal or ultrathin elevation to provide a thin flap with thick skin coverage for plantar foot reconstruction. In this article, the authors present a case series exemplifying the utility of the thinned parascapular flap elevated at the ultrathin plane for reconstruction of weight-bearing plantar foot defects.
由于需要相对较薄的覆盖且同时具备耐用性，负重性足底缺损的最佳重建具有挑战性。内侧足底皮瓣能提供极佳的组织匹配，但并非总是可用或合适。显微外科游离皮瓣重建提供了多种覆盖选择。然而，很少有皮瓣薄到足以进行适当塑形，但仍能提供厚实的真皮以实现耐用的负重功能，特别是对于体型中等或肥胖的患者。背部和臀部拥有人体最厚的皮肤，但这些皮瓣在足部的应用相对较少受到关注。肩胛上平面掀起法越来越多地用于提供与周围组织厚度相匹配的定制覆盖。甚至更薄的“超薄皮瓣”是在Scarpa筋膜层浅面的皮下脂肪内掀起的。将这一概念专门应用于来自背部且能提供更厚皮肤的皮瓣的研究较少。肩胛皮瓣和肩胛旁皮瓣具有许多用于足部重建的理想特性，包括供区并发症少、蒂部解剖简单、蒂部短以便能合适地到达附近的受区血管，以及皮肤厚以实现耐用的负重功能。然而，到目前为止，这些皮瓣似乎被忽视了，未被视为进行肩胛上或超薄掀起以提供具有厚皮肤覆盖的薄皮瓣用于足底重建的候选皮瓣。在本文中，作者展示了一系列病例，例证了在超薄平面掀起的薄型肩胛旁皮瓣用于重建负重性足底缺损的效用。
