足底缺损的修复及感觉重建的随访

The sensory function after repair of the sole defects

目的探讨足底缺损的修复方法及感觉重建的必要性。方法 1990年 6月～ 1999年 12月对 29例足底缺损病例根据负重区和非负重区分别采用皮瓣和全厚皮片移植的方法进行修复，其中吻合皮神经和 (或 )带皮神经蒂移植者 16例，并对术式和疗效进行分析。结果术后皮瓣坏死 1例，其余病例一期愈合。随访 1～ 9年，平均 3.8年。皮瓣修整 1例，发生溃疡 1例，溃疡发生率为 3.4％。 16例行吻合皮神经和 (或 )带皮神经蒂皮瓣移植者术后感觉恢复达 S2～ S3级； 13例未感觉重建而只采用皮瓣和全厚皮片移植的方法进行修复者术后以深痛觉为主，即 S1级，皮瓣边缘 1～ 2 cm范围内有不同程度的浅感觉恢复，即 S2级。感觉重建与否与溃疡发生无明显的关系。结论足底负重区必须选择皮瓣修复，足内侧皮瓣、足底内侧皮瓣、趾动脉皮瓣和股前外侧皮瓣可作为该区修复的首选皮瓣。非负重区首选全厚皮片修复。因非感觉皮瓣移植后也能获得保护性感觉，故感觉重建是次要的。

Objective To study the methods of repairing the sole defects and reconstruction of the sensory function. Methods Twenty- nine cases of sole defect were repaired with flaps and full- thickness grafting according to the weight- bearing area and non- weight- bearing area. Sixteen cases had reconstruction of the sensory nerves. Results Twenty- nine cases were followed up for 1－ 9 years. One case failed. One case required thinning the flap. Twenty- eight cases have gained normal weight bearing ambulation. Ulcer occurred in one case, giving an ulcer rate of 3.4％ . The sensation have recovered to S2－ S3 in 16 cases repaired with reconstruction of cutaneous sensory nerves. Thirteen cases repaired with non- innervated flaps and full- thickness grafting showed deep pain sensation, and over the 1－ 2 cm area coverage around the flaps there was light touch sensation. No significant difference was found in the ulcer rate between reinnervated and non- innervated flaps. Conclusion Defects of the weight- bearing area in sole must be repaired with flaps. The medial foot island flap, medial pedal island flap, toe arterial flap and anterolateral thigh flap are the appropriate options. Defects of the non- weight- bearing area could be repaired with full- thickness grafting. The transplantation of non- sensory skin flaps can re- establish the sensory function, so the reconstruction of sensory nerve is of minor importance.