Moroz V I, Iudenich A A, Mikhaílov I A, Kafarov T G, Kuntsevich G I
Department of Reconstructive and Plastic Surgery, Institute of Surgery,Moscow.
Khirurgiia (Mosk). 1997(7):40-3.
The results of 40 microsurgical transplantations of complex flaps in 37 patients with cicatricial-ulcerous foot deformations are analysed. The surgery was indicated in cicatricial soft tissues defects, unhealing trophic ulcers, inability to use local tissues for plastic surgery. The scapular flap was used in 34 cases, thoraco-dorsal flap in 5 cases, deltoid flap in 1 case. It was necessary to increase the square of the scapular flap in case of a vast cicatricial soft tissue defect of the talocrural joint and dorsal surface of the foot and the sole. A special expander was used for this purpose. The importance of ultrasound methods for evaluation of the vessels supplying the sole, as well as the state of the microvascular anastomoses in postoperative period is stressed. The long-term results were followed up for 1.5 to 5 years in 29 of 37 patients. The good results was noted in 18 patients, satisfactory in 7 patients, complications (unhealed trophic ulcers) in 4 patients. The complications were caused by calcanel tuber deformation with osteophyte, osteomyelitis, inradically removed scars.
分析了37例瘢痕性足部溃疡畸形患者40例复杂皮瓣显微外科移植的结果。手术适用于瘢痕性软组织缺损、营养性溃疡不愈合、无法利用局部组织进行整形手术的情况。34例采用肩胛皮瓣，5例采用胸背皮瓣，1例采用三角肌皮瓣。当踝关节和足背及足底存在大面积瘢痕性软组织缺损时，有必要扩大肩胛皮瓣的面积。为此使用了一种特殊的扩张器。强调了超声方法在评估供应足底血管以及术后微血管吻合状态方面的重要性。37例患者中的29例进行了1.5至5年的长期随访。18例患者效果良好，7例患者效果满意，4例患者出现并发症（营养性溃疡未愈合）。并发症是由跟骨结节变形伴骨赘、骨髓炎、瘢痕切除不彻底引起的。
