带血管神经蒂足底内侧皮瓣修复足跟部皮肤缺损

APPLICATION OF MEDIAL PLANTAR FLAP WITH NEUROVASCULAR PEDICLE IN REPAIRING HEEL SKIN DEFECTS

目的探讨带血管神经蒂足底内侧皮瓣修复足跟部皮肤软组织缺损的临床疗效。方法自2005年12月—2009年8月应用带血管神经蒂足底内侧皮瓣修复足跟部皮肤软组织缺损17例,其中外伤15例,跟骨骨髓炎2例。皮肤软组织缺损面积为3cm×2cm～10cm×7cm,17例患者均有跟腱和(或)跟骨外露,4例伴有跟骨开放性骨折,2例因骨髓炎扩创后跟骨部分缺损。根据清(扩)创后皮肤缺损面积,设计皮瓣面积为5cm×3cm～11cm×8cm。其中2例皮瓣内包含部分足拇展肌肌腹,填塞跟骨缺损。皮瓣供区游离植皮。结果 17例皮瓣均成活良好。术后随访3～32个月,平均19.5个月,皮瓣外形满意,可重建足跟部感觉,患足行走功能良好,未见磨损、溃疡发生。结论应用足底非负重区组织修复足底负重区皮肤软组织缺损,不仅外形美观、功能良好,而且具有较好的感觉。带血管神经蒂足底内侧皮瓣是修复足跟部皮肤软组织缺损的良好方法之一。

Objective To discuss the clinical effects of medial plantar flap with neurovascular pedicle in repairing heel skin defects. Methods A total of 17 cases of heel skin defects were repaired with medial plantar flap from December 2005 to August 2009, including 15 cases of trauma and 2 cases of calcaneal osteomyelitis. The area of soft tissue defects ranged from 3cm × 2cm to 10cm × 7cm. All the 17 cases had tendon and （or） calcaneal exposure. Four cases had calcaneal open fracture and 2 cases resulted from the debridement of osteomyelitis. According to the defects area after the debridement, the flaps area were designed as 5cm x 3cm to llcm x 8cm. The flap of two cases included part abductor hallucis belly to cram the calcaneal defects. The flap donor was treated by the skin graft. Results The flap of 17 cases survived well. The follow - up time after operation was from 3 to 32 months, with the average of 19.5 months. The appearance of flap was good and it could rebuild the calcaneal sense. The patients walked well, without any abrasion or ulcer. Conclusion The thenar tissue of non weight - bearing area could be applied to repair the soft tissue defects of weight - bearing area, not only with beautiful appearance and favorable function, but also with preferable feelings. The plantar medial flap with neurovascular pedicle is one of the ideal methods to repair the soft tissue defects of heel skin.