Ferreira M C, Besteiro J M, Monteiro Júnior A A, Zumiotti A
Division of Plastic Surgery, Faculty of Medicine, University of São Paulo (FMUSP), Brazil.
Microsurgery. 1994;15(1):33-6. doi: 10.1002/micr.1920150110.
Reconstruction of the foot using microvascular flaps has been widely performed in the last 15 years but the choice of flap to repair some areas in the foot remains controversial. We present a series of 128 free flaps to the foot performed during the period of 1975-1990. One hundred and seventeen had a successful outcome (91%). The etiology of the problem was traumatic in 94, congenital in 10, tumor in 9, and chronic ulcerations due to vascular problems in 15. The indications for a specific flap depended on the site and extension of the foot problem, and were divided into four groups: 1. Dorsum of the foot. Cutaneous parascapular flap was the best choice. 2. The sole-weight-bearing area. We favored the use of the latissimus dorsi muscle flap covered with a split thickness skin graft, done immediately. A proper tailoring of the flap and postoperative care by the patient are very important to maintain the result without ulceration. Tactile sensation does not seem to be essential. 3. The area over the calcaneus tendon. We have used cutaneous flaps such as the parascapular and lateral arm flap or fascial flaps covered by split thickness skin grafts (STSG). The fascia used were the serratus or the parascapular. 4. Complex trauma problems with extensive skin loss or chronic ulcerations due to vascular diseases: the latissimus dorsi musculocutaneous or muscle plus STSG was mostly used. The overall number of donor areas were 5 groins, 48 parascapular, 2 gluteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial flaps.
在过去15年中，使用微血管皮瓣进行足部重建已广泛开展，但对于修复足部某些区域的皮瓣选择仍存在争议。我们展示了1975年至1990年期间对足部进行的一系列128例游离皮瓣手术。其中117例取得成功（成功率91%）。导致问题的病因中，创伤性的有94例，先天性的有10例，肿瘤性的有9例，血管问题导致的慢性溃疡有15例。特定皮瓣的适应证取决于足部问题的部位和范围，分为四组：1. 足背。肩胛旁皮瓣是最佳选择。2. 足底负重区。我们倾向于立即使用覆盖中厚皮片的背阔肌肌皮瓣。对皮瓣进行适当裁剪以及患者术后护理对于维持效果且不发生溃疡非常重要。触觉似乎并非必不可少。3. 跟腱上方区域。我们使用了如肩胛旁皮瓣和上臂外侧皮瓣等皮瓣或覆盖中厚皮片的筋膜瓣。使用的筋膜为锯肌筋膜或肩胛旁筋膜。4. 伴有广泛皮肤缺损的复杂创伤问题或血管疾病导致的慢性溃疡：大多使用背阔肌肌皮瓣或肌肉加中厚皮片。供区总数为5个腹股沟、48个肩胛旁、2个臀沟皮瓣、4个上臂外侧、61个背阔肌和8个筋膜瓣。
