足底内侧岛状皮瓣转移修复足跟部恶性黑色素瘤切除术后创面的临床效果

Medial plantar island flap for soft tissue reconstruction of the heel after excision of melanoma

目的 探讨足底内侧岛状皮瓣修复足跟部皮肤恶性黑色素瘤切除术后软组织缺损创面的临床效果.方法 选取足跟部恶性黑色素瘤明确诊断患者5例,男3例,女2例.行足跟局部扩大切除手术,切缘距病灶2 cm,深度达跟骨骨膜,根据缺损大小及足底内侧动脉解剖学特点,选择适合的带神经、血管蒂足底内侧皮瓣移位修复足跟部软组织缺损,随访8～14个月.结果 5例术后皮瓣全部成活,皮瓣感觉功能良好,足部外形满意,能正常承重行走,无皮瓣溃疡发生,肿瘤未见局部复发,患足功能与对侧相比无明显差异.结论 足底内侧岛状皮瓣修复足跟部恶性黑色瘤切除术后创面,是一种行之有效的方法.

Objective To study the efficacy of medial plantar island flap for repairing soft tissue defect of the heel after excision of melanoma.Methods Five patients （including 3 males and 2 females） with malignant melanoma were treated.All lesions were located in the heel and were proved by pathological examination.Local extensive resection was performed in all cases.The surgical margin used for excision of melanoma was 2 cm,and the depth used was deep into periosteum of the calcaneus.Plantar medial artery island skin flaps were applied in the reparation according to the size of heel soft tissue defect and anatomic study.The postoperative follow-up was 8 to 14 months.Results The surgical reparation was successful in all 5 cases.The plantar medial artery was very suitable to cover the surgical wound surface and to recover the function and sense.Before 3 months the sense of flaps remained on the donor area and later went to the heel gradually.All patients remained alive and no tumor recurrence was observed.All the patients were walking normally and had protective sensation in the new heel pad comparable to the opposite normal heel.Two patients with more than 10 years follow-up were reported.Conclusions Plantar medial island flap can be used to repair the wound after malignant melanoma resection in the heel,which is an effective method.