Duncan M J, Zuker R M, Manktelow R T
J Reconstr Microsurg. 1985 Jan;1(3):201-8. doi: 10.1055/s-2007-1007075.
Five cases of chronic ulceration following skin graft resurfacing of the weight bearing surface of the heel are presented. All were managed with debridement and coverage with a free innervated dorsalis pedis tissue transfer. The technical refinements that have contributed to the reliability of the flap include careful distal identification of the first dorsal metatarsal artery (FDMA) and division of the dorsalis pedis artery (DPA) under direct vision below the takeoff of the FDMA. Donor site morbidity has been minimized by taking care to preserve the extensor paratenon as a bed for the subsequent skin graft and by immobilization of the donor foot with plaster and bed rest for 10 days. Four of the patients were followed for 2, 4, 4, and 6 years; one was lost to follow-up. All were active with protective sensation in their flaps. No instances of flap breakdown and no significant donor site morbidity were noted. The dorsalis pedis innervated free tissue transfer is recommended as a reliable procedure for resurfacing weight bearing areas of the foot when simpler methods have failed.
本文报告了5例足跟负重面皮肤移植后慢性溃疡的病例。所有病例均采用清创术，并通过游离带神经的足背组织转移进行覆盖。有助于皮瓣可靠性的技术改进包括在第一跖背动脉（FDMA）远端仔细辨认，并在FDMA起始点下方直视下切断足背动脉（DPA）。通过小心保留伸肌支持带作为后续皮肤移植的床，并将供区足部用石膏固定和卧床休息10天，使供区并发症降至最低。4例患者分别随访了2年、4年、4年和6年；1例失访。所有患者皮瓣均有保护性感觉且活动自如。未发现皮瓣坏死病例，供区也无明显并发症。当更简单的方法失败时，建议采用带神经的足背游离组织转移术作为修复足部负重区的可靠方法。
