选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损
|
摘要
目的探讨选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损的疗效。方法 2013年4月—2015年8月,收治8例不同原因导致的足跟及足跟后区缺损患者。男6例,女2例;年龄15~49岁,平均31.2岁。创面范围为14 cm×10 cm~19 cm×14 cm。手术切取对侧股前外侧皮瓣,将拟覆盖足底非承重区和足跟后区部分行不同程度修薄。皮瓣切取范围为14 cm×10 cm~19 cm×14 cm。供区游离植皮修复。结果术后皮瓣均顺利成活,创面Ⅰ期愈合。2例发生供区局部皮片坏死,经换药后愈合;其余植皮均顺利成活。患者均获随访,随访时间8~20个月,平均12.3个月。患者恢复正常行走,其中2例皮瓣发生破损,经换药后自愈。7例皮瓣外观无臃肿,不影响穿鞋;1例于术后1年行二期皮瓣修薄术。结论选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损,可获得较理想足部外观和功能。
Objective To investigate the effectiveness of selectively thinning of the free anterolateral thigh flap in repair of the heel skin and soft tissue defect. Methods Between April 2013 and August 2015, 8 patients with tissue defect of heel caused by different reasons were recruited. There were 6 males and 2 females with an average age of 31.2 years(range, 15-49 years). The size of wound ranged from 14 cm×10 cm to 19 cm×14 cm. All the wounds were repaired with the contralateral free anterolateral thigh flap. The partial flap which was going to repair the defects of the heel and nonweight-bearing area of planta pedis was selectively thinned. The size of flap ranged from 14 cm×10 cm to 19 cm×14 cm.The donate site was repaired by skin grafting. Results All flaps survived after operation, and wounds healed by first intention. The marginal necrosis of skin graft occurred in 2 cases, and healed after changing the dressing. The other skin grafts survived. All patients were followed up 8-20 months(mean, 12.3 months). All patients could walk normally. During follow-up, 2 flaps were injured and cured after symptomatic management. The appearance of flap was good in 7 cases with no influence in wearing shoes. Only 1 patient received the second-stage surgery of thinning the flap after 1 year.Conclusion Application of the selectively thinning of the free anterolateral thigh flap can repair the heel skin and soft tissue defects, and achieve an ideal appearance and function.
Objective To investigate the effectiveness of selectively thinning of the free anterolateral thigh flap in repair of the heel skin and soft tissue defect. Methods Between April 2013 and August 2015, 8 patients with tissue defect of heel caused by different reasons were recruited. There were 6 males and 2 females with an average age of 31.2 years(range, 15-49 years). The size of wound ranged from 14 cm×10 cm to 19 cm×14 cm. All the wounds were repaired with the contralateral free anterolateral thigh flap. The partial flap which was going to repair the defects of the heel and nonweight-bearing area of planta pedis was selectively thinned. The size of flap ranged from 14 cm×10 cm to 19 cm×14 cm.The donate site was repaired by skin grafting. Results All flaps survived after operation, and wounds healed by first intention. The marginal necrosis of skin graft occurred in 2 cases, and healed after changing the dressing. The other skin grafts survived. All patients were followed up 8-20 months(mean, 12.3 months). All patients could walk normally. During follow-up, 2 flaps were injured and cured after symptomatic management. The appearance of flap was good in 7 cases with no influence in wearing shoes. Only 1 patient received the second-stage surgery of thinning the flap after 1 year.Conclusion Application of the selectively thinning of the free anterolateral thigh flap can repair the heel skin and soft tissue defects, and achieve an ideal appearance and function.
引文
1蔺海龙,田宝祥,刘凤彬,等.足底内侧动脉皮瓣修复足跟部严重冻伤创面15例.中华烧伤杂志,2014,30(3):282-283.
2Kharmandayan V,Harada MN,Anacleto ACF,et al.Weightbearing plantar reconstruction after resection of melanoma using the medial plantar flap.Plast Reconstr Surg,2015,136(4S):166-167.
3周晓,薛明宇,芮永军,等.带外踝后腓动脉穿支的V-Y推进皮瓣修复儿童足跟后区较小创面.中华整形外科杂志,2015,31(4):288-291.
4唐修俊,王波,魏在荣,等.保留感觉的胫后动脉穿支皮瓣V-Y推进修复踝周创面.中国修复重建外科杂志,2015,29(12):1515-1518.
5杨英才,孙振忠,张重阳,等.以胫后动脉为蒂的逆行岛状皮瓣并联胫骨瓣修复足跟皮肤及跟骨缺损.中华整形外科杂志,2015,31(2):143-144.
6巨积辉,金光哲,刘跃飞,等.小儿足跟部复合组织缺损的皮瓣修复.中华小儿外科杂志,2012,33(3):238-240.
7董福,朱金荣,李云峰,等.序贯封闭式负压引流技术与带蒂皮瓣治疗儿童后足摩托车轮辐伤.中国修复重建外科杂志,2015,29(4):462-466.
8唐修俊,魏在荣,王波,等.游离股前外侧皮瓣修复四肢皮肤软组织缺损22例.中华烧伤杂志,2015,31(4):308-310.
9赵勇刚,杨铭华,郭德华,等.四种游离皮瓣修复前足及足底软组织缺损.中华显微外科杂志,2014,37(2):193-194.
10尹路,宫可同,殷中罡,等.游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察.中国修复重建外科杂志,2017,31(3):319-322.
11曹广超,郑大伟,孙峰,等.预构感觉皮瓣修复足跟软组织撕脱伤.中国修复重建外科杂志,2015,29(2):198-201.
12Furukawa M,Nakagawa K,Hamada T.Long-term complications of reconstruction of the heel using a digitorum brevis muscle flap.Ann Plast Surg,1993,30(4):354-358.
13Malhotra K,Lian TS,Chakradeo V.Vascular anatomy of anterolateral thigh flap.Largngoscope,2008,118(4):589-592.
14张文亚,伍辉国,胡玉祥,等.修薄股前外侧皮瓣游离移植修复足踝部软组织缺损.中华显微外科杂志,2011,34(5):400-401.
15Kuran I,Turgut G,Bas L,et al.Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area.Plast Reconstr Surg,2000,105(2):574-580.
16唐举玉,李康华,谢松林,等.股前外侧皮瓣修复足跟大面积软组织缺损的感觉重建探讨.中华显微外科杂志,2012,35(4):267-271.
2Kharmandayan V,Harada MN,Anacleto ACF,et al.Weightbearing plantar reconstruction after resection of melanoma using the medial plantar flap.Plast Reconstr Surg,2015,136(4S):166-167.
3周晓,薛明宇,芮永军,等.带外踝后腓动脉穿支的V-Y推进皮瓣修复儿童足跟后区较小创面.中华整形外科杂志,2015,31(4):288-291.
4唐修俊,王波,魏在荣,等.保留感觉的胫后动脉穿支皮瓣V-Y推进修复踝周创面.中国修复重建外科杂志,2015,29(12):1515-1518.
5杨英才,孙振忠,张重阳,等.以胫后动脉为蒂的逆行岛状皮瓣并联胫骨瓣修复足跟皮肤及跟骨缺损.中华整形外科杂志,2015,31(2):143-144.
6巨积辉,金光哲,刘跃飞,等.小儿足跟部复合组织缺损的皮瓣修复.中华小儿外科杂志,2012,33(3):238-240.
7董福,朱金荣,李云峰,等.序贯封闭式负压引流技术与带蒂皮瓣治疗儿童后足摩托车轮辐伤.中国修复重建外科杂志,2015,29(4):462-466.
8唐修俊,魏在荣,王波,等.游离股前外侧皮瓣修复四肢皮肤软组织缺损22例.中华烧伤杂志,2015,31(4):308-310.
9赵勇刚,杨铭华,郭德华,等.四种游离皮瓣修复前足及足底软组织缺损.中华显微外科杂志,2014,37(2):193-194.
10尹路,宫可同,殷中罡,等.游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察.中国修复重建外科杂志,2017,31(3):319-322.
11曹广超,郑大伟,孙峰,等.预构感觉皮瓣修复足跟软组织撕脱伤.中国修复重建外科杂志,2015,29(2):198-201.
12Furukawa M,Nakagawa K,Hamada T.Long-term complications of reconstruction of the heel using a digitorum brevis muscle flap.Ann Plast Surg,1993,30(4):354-358.
13Malhotra K,Lian TS,Chakradeo V.Vascular anatomy of anterolateral thigh flap.Largngoscope,2008,118(4):589-592.
14张文亚,伍辉国,胡玉祥,等.修薄股前外侧皮瓣游离移植修复足踝部软组织缺损.中华显微外科杂志,2011,34(5):400-401.
15Kuran I,Turgut G,Bas L,et al.Comparison between sensitive and nonsensitive free flaps in reconstruction of the heel and plantar area.Plast Reconstr Surg,2000,105(2):574-580.
16唐举玉,李康华,谢松林,等.股前外侧皮瓣修复足跟大面积软组织缺损的感觉重建探讨.中华显微外科杂志,2012,35(4):267-271.