应用足底角形穿支皮瓣修复足跟及前跖底缺损

Application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar

目的 探讨应用足底角形穿支皮瓣修复足跟及前跖底缺损的方法及临床效果.方法 以缺损部位为皮瓣头端设计角形穿支筋膜皮瓣,弓形侧及凹陷侧均应切开深筋膜,并携带跖腱膜,将其旋转推进覆盖创面,皮瓣内尽可能包含2～3个穿支血管,必要时可结扎源血管（足底外侧动脉或足底内侧动脉）,以利于增加皮瓣旋转推进距离.2010年1月至2012年10月,设计应用角形穿支皮瓣修复7例足底皮肤缺损,缺损范围约1.5 cm×2.0 cm～4.0 cm×5.0cm,皮瓣切取面积为7 cm×3 cm～13 cm× 7 cm.结果 术后6例角形穿支皮瓣全部成活,另1例皮瓣远端出现裂开坏死,残留小创面经换药、二期全层皮片移植愈合.供、受区伤口愈合良好,经3个月至2年随访,色泽、质地、外形及功能均恢复较好.结论 应用足底角形穿支皮瓣,供区缺损无需切取皮片移植,由足底同源性厚实坚韧皮肤修复,是修复足底部负重区软组织缺损的一种较优越方法.

Objective To investigate the application of the plantar horn shaped fasciocutaneous perforator flaps for the reconstruction of the defects on heel and fore plantar.Methods The proximal end of the plantar fasciocutaneous perforator flaps were at the edge of defects.The deep fascia was cut off at the both sides of flaps.The plantar fascia should be included into the flaps.Then the flaps were rotated to cover the defects,containing two or three perforators.If necessary,the original supplying vessels could be cut off to facilitate the advancement of flaps.Results From Jan.2010 to Oct.2012,7 cases with plantar defects were treated with the horn shaped perforator flaps.The defects size ranged from 1.5 cm × 2.0 cm to 4.0 cm×5.0 cm with the size of the flaps ranging from 7 cm ×3 cm to 13 cm × 7 cm.All the flaps survived completely with primary healing both on donor and recipient sites.The flap color,texture,function and appearance were satisfactory during the follow-up period of 3-24 months.Conclusions The plantar horn shaped perforator flap can reconstruct the defects at plantar weight-bearing area with the similar thick skin tissue,which faciliates the functional reconstruction.No skin graft is necessary for the defect at donor site.