Zhang Wenchao, Guo Luqi, Hao Yan, Wang Liangya, Zhang Chao, Wang Yun, Huang Jiuzuo, Zeng Ang, Long Xiao
Department of Plastic and Aesthetic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China.
Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Sep 15;39(9):1086-1090. doi: 10.7507/1002-1892.202506087.
To evaluate the effectiveness of the innervated medial plantar flap for reconstructing soft tissue defects, particularly in the weight-bearing zone, after resection of foot tumors.
A retrospective analysis was conducted on 12 patients with malignant skin and soft tissue tumors of the foot treated between October 2023 and December 2024. The cohort included 8 males and 4 females, aged 42-67 years (mean, 57.5 years). Tumor types comprised malignant melanoma (5 cases), squamous cell carcinoma (4 cases), arsenical keratosis (2 cases), and tumor-induced osteomalacia (1 case). Soft tissue defects located in the heel weight-bearing region in 10 cases and non-weight-bearing ankle region in 2 cases, with defect sizes ranging from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. Preoperative photon-counting CT angiography (PC-CTA) was performed to assess the medial plantar artery and its perforators. All patients underwent radical tumor resection with confirmed negative margins. The resulting defects were reconstructed using a innervated medial plantar flap incorporating sensory branches of the medial plantar nerve. The flap donor site was covered with a split-thickness skin graft harvested from the ipsilateral inguinal region.
The operation was successfully completed in all 12 patients. All flaps survived completely without vascular compromise, partial necrosis, or total loss. Incisions healed primarily without dehiscence or infection. Minor skin graft necrosis occurred at the donor site in 3 patients, which healed within 2-3 weeks with routine dressing changes. No donor site complication (e.g., tendon or nerve injury) occurred. Patients were followed up 2-16 months (mean, 10.3 months). At last follow-up, there was no tumor recurrence. Flaps exhibited good color and texture match with surrounding tissue, restored sensation, and all feet achieved normal weight-bearing activity.
The innervated medial plantar flap, precisely designed based on PC-CTA localization, provides reliable blood supply and effective sensory restoration. It is an ideal method for reconstructing soft tissue defects after foot tumor resection, especially in the heel weight-bearing region.
评估带神经的足底内侧皮瓣在修复足部肿瘤切除术后软组织缺损，尤其是负重区软组织缺损中的有效性。
对2023年10月至2024年12月期间接受治疗的12例足部恶性皮肤和软组织肿瘤患者进行回顾性分析。该队列包括8名男性和4名女性，年龄在42 - 67岁之间（平均57.5岁）。肿瘤类型包括恶性黑色素瘤（5例）、鳞状细胞癌（4例）、砷角化病（2例）和肿瘤性骨软化症（1例）。软组织缺损位于足跟负重区10例，非负重踝关节区2例，缺损大小为4.0 cm×3.0 cm至6.0 cm×4.0 cm。术前行光子计数CT血管造影（PC - CTA）评估足底内侧动脉及其穿支。所有患者均接受肿瘤根治性切除，切缘确认阴性。使用包含足底内侧神经感觉支的带神经足底内侧皮瓣修复 resulting 缺损。皮瓣供区用取自同侧腹股沟区的中厚皮片覆盖。
12例患者手术均顺利完成。所有皮瓣完全存活，无血管危象、部分坏死或完全坏死。切口一期愈合，无裂开或感染。3例患者供区出现轻微皮片坏死，经常规换药2 - 3周愈合。未发生供区并发症（如肌腱或神经损伤）。患者随访2 - 16个月（平均10.3个月）。末次随访时无肿瘤复发。皮瓣颜色和质地与周围组织匹配良好，感觉恢复，所有足部均实现正常负重活动。
基于PC - CTA定位精确设计的带神经足底内侧皮瓣，提供可靠的血供和有效的感觉恢复。它是修复足部肿瘤切除术后软组织缺损，尤其是足跟负重区软组织缺损的理想方法。
