Weinzweig N, Davies B W
Department of Orthopaedic Surgery, University of Illinois at Chicago and Cook County Hospital 60612-7316, USA.
Plast Reconstr Surg. 1998 Nov;102(6):1999-2005. doi: 10.1097/00006534-199811000-00029.
Twenty-five patients underwent soft-tissue reconstruction of the different anatomic regions of the foot and ankle using the microvascular radial forearm free flap. The patients, 19 men and 6 women, ranged in age from 3 to 80 years (mean, 48.4 years). Indications for the surgery included diabetes and/or vascular insufficiency (10 patients), trauma (9 patients), tumor (3 patients), gunshot wound (2 patients), and burn (1 patient). Osteomyelitis occurred in patients with traumatic (3 patients) and diabetic (3 patients) wounds. The weight-bearing surface of the foot was involved in eight patients. Defects ranged in size from 45 to 210 cm2 (mean, 100.4 cm2). The radial forearm flap was successful in 23 of 25 cases (92 percent). Flap complications included flap loss (two patients), infection (three patients), and minor wound dehiscence at the flap-leg skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor site complications included partial skin graft loss with tendon exposure in two patients; both healed with conservative management. Recurrent or persistent osteomyelitis was not seen in any of the patients. Of the eight patients with weight-bearing flaps, four were ambulatory, one had limited ambulation, one was nonambulatory, one had too short a follow-up, and one suffered flap loss. Two patients required modified shoes. Debulking was performed in one patient. Follow-up ranged from 2 to 72 months (mean, 24.9 months). The radial forearm flap meets most of the anatomic prerequisites for the ideal foot flap. It facilitates the restoration of normal foot contour by replacing "like-with-like," allowing patients to use normal shoes without the need for debulking (except in one patient); it provides a durable and stable weight-bearing plantar surface during ambulation; it achieves excellent aesthetic results without the dryness or cracking of the hypertrophied skin-grafted muscle; and it permits sensory reinnervation. We have found it especially useful for resurfacing the dorsum, ankle, and forefoot, moderate-sized defects, weight-bearing surfaces, and osteomyelitic wounds.
25例患者采用游离桡侧前臂微血管皮瓣对足踝部不同解剖区域进行软组织重建。患者中男性19例，女性6例，年龄3至80岁（平均48.4岁）。手术适应证包括糖尿病和/或血管功能不全（10例）、创伤（9例）、肿瘤（3例）、枪伤（2例）和烧伤（1例）。创伤患者（3例）和糖尿病患者（3例）伤口发生骨髓炎。8例患者足部负重面受累。缺损面积为45至210平方厘米（平均100.4平方厘米）。25例中23例（92%）桡侧前臂皮瓣手术成功。皮瓣并发症包括皮瓣坏死（2例）、感染（3例）以及皮瓣与腿部皮肤界面处轻度伤口裂开（2例）。2例患者出现复发性溃疡；均为负重皮瓣的糖尿病患者。供区并发症包括2例患者部分植皮丢失伴肌腱外露；经保守治疗均愈合。所有患者均未出现复发性或持续性骨髓炎。8例负重皮瓣患者中，4例可行走，1例行走受限，1例不能行走，1例随访时间过短，1例皮瓣坏死。2例患者需要穿改良鞋。1例患者进行了减容手术。随访时间为2至72个月（平均24.9个月）。桡侧前臂皮瓣满足理想足皮瓣的大多数解剖学要求。通过“同类替代”有助于恢复正常足部外形，使患者无需减容（1例患者除外）即可穿正常鞋子；行走时提供持久稳定的负重足底表面；获得极佳的美学效果，不会出现移植皮肤的肌肉肥厚干燥或开裂；并允许感觉再支配。我们发现它特别适用于足背、踝部和前足的创面修复、中等大小的缺损、负重面以及骨髓炎伤口。
