Graf P, Kalpen A, Biemer E
Department of Plastic and Reconstructive Surgery, Technical University, Munich, Germany.
Microsurgery. 1995;16(3):149-54. doi: 10.1002/micr.1920160307.
The anatomy of heel vascularization implies that there is a high risk of necrosis if degloved soft tissue is only sutured back to its former position. Two patients who had sustained similar degloving injuries of the heel are presented. One of them was treated by primary revascularization and the other by secondary reconstruction with a dorsalis pedis flap. The postoperative outcome was investigated to show the value of the salvage operation. Dynamic pressure distribution gait analysis was performed barefoot and in the shoe to investigate postoperative weightbearing on the reconstructed areas. In contrast to the heel reconstruction with the dorsalis pedis flap, the revascularized original heel was stable without development of soft tissue lesions. The salvaged original heel tissue enabled a physiologic pressure distribution beneath the heel and a more physiological rollover process of the foot, comparable to the contralateral foot. In degloving injuries of the heel, revascularization of the soft tissue should be considered whenever possible.
足跟血管分布的解剖结构表明，如果将脱套的软组织仅缝合回其先前位置，发生坏死的风险很高。本文介绍了两名足跟遭受类似脱套伤的患者。其中一名患者接受了一期血运重建治疗，另一名患者接受了带蒂足背皮瓣二期重建治疗。对术后结果进行了研究，以显示挽救手术的价值。在裸足和穿鞋状态下进行动态压力分布步态分析，以研究重建区域术后的负重情况。与带蒂足背皮瓣进行足跟重建不同，血运重建后的原始足跟稳定，未出现软组织病变。挽救的原始足跟组织使足跟下方能够实现生理压力分布，并且足部的翻转过程更接近生理状态，与对侧足部相当。在足跟脱套伤中，应尽可能考虑对软组织进行血运重建。
