Jeng S F, Wei F C
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, Republic of China.
Plast Reconstr Surg. 1997 May;99(6):1695-703; discussion 1704-5.
Between 1989 and 1994, 28 patients who had plantar avulsion injuries were treated. Patient ages averaged 30 years (range 7 to 62 years). Length of follow-up averaged 20 months. Five patients (18 percent) were classified as having suprafascial avulsions, where the shearing plane was limited to the superficial subcutaneous layer, leaving the deeper subcutaneous fat. Twenty-three patients (82 percent) were classified as having subfascial avulsions, where the stripping force extended deep into the plantar aponeurosis. For the suprafascial avulsions, defatting these flaps and replacing them with full-thickness skin grafts was the treatment of choice. For the subfascial group, the avulsions with proximally based flaps (4 patients) that were well nourished by mediolaterally orientated neurovascular bundles could be treated by sewing the avulsed flaps tension-free back to their former positions. For the subfascial group with distally based flaps (19 patients), the avulsed flaps were supplied by anteroposteriorly orientated vascular plexuses that were compromised. Primary revascularization of the soft tissue should be considered whenever possible. Among them, 10 patients attempted microvascular salvage. Only 3 patients succeeded with revascularization. In the remaining 16 patients, the avulsed flaps went on to partial or complete necrosis, and these required secondary reconstruction with free muscle flaps for heel defects.
1989年至1994年间，对28例足底撕脱伤患者进行了治疗。患者平均年龄为30岁（范围7至62岁）。平均随访时间为20个月。5例患者（18%）被归类为筋膜上撕脱伤，其剪切平面仅限于浅皮下层，深层皮下脂肪保留。23例患者（82%）被归类为筋膜下撕脱伤，其剥离力深入到足底腱膜。对于筋膜上撕脱伤，首选的治疗方法是对这些皮瓣进行去脂，并用全厚皮片进行替代。对于筋膜下组，带有由内外侧神经血管束良好滋养的近端蒂皮瓣的4例撕脱伤患者，可通过将撕脱皮瓣无张力地缝合回其原来位置进行治疗。对于带有远端蒂皮瓣的19例筋膜下组患者，撕脱皮瓣由前后向血管丛供血，这些血管丛受损。只要有可能，就应考虑对软组织进行一期血管重建。其中，10例患者尝试进行微血管挽救。只有3例患者血管重建成功。在其余16例患者中，撕脱皮瓣发生部分或完全坏死，这些患者需要用游离肌皮瓣对足跟缺损进行二期重建。
