游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损

Free medial plantar flap for treatment of palm and wrist large area skin defects

目的探讨携带足底内侧神经皮支的足底内侧皮瓣修复手掌及腕部大面积皮肤缺损的治疗效果。方法自2008年1月至2016年1月，我们共收治手掌及腕部皮肤软组织缺损患者16例，其中伴肌腱外露者10例，伴骨折者4例，皮肤缺损范围为6cm×5cm～12cm×10cm，均采用携带足底内侧神经皮支的足底内侧皮瓣修复，皮瓣切取面积为7cm×6cm-13cm×11cm，均缝合神经重建感觉。结果术后随访时间为6—24个月，平均12个月。皮瓣部分坏死1例，经换药后愈合，其余15例皮瓣全部存活。皮瓣两点分辨觉为6～12mm，感觉恢复满意，无持物不适感。皮肤质地接近正常，外观满意，局部耐磨。供瓣区植皮均Ⅰ期愈合，对行走无明显影响。结论足底内侧皮瓣可切取面积较大，足部解剖结构与手发育同源，质地接近，可携带神经重建感觉，是修复手掌及腕部大面积缺损的理想皮瓣之一。

Objective To discuss the clinical effect of medial plantar flap with cutaneous branch of medial plantar nerve for repair of large area skin defects in palm and wrist. Methods From January 2008 to January 2016, 16 patients with palm and wrist soft tissue defects were treated by medial plantar flap with cutaneous branch of medial plantar nerve. Among them, 10 cases were combined with tendon exposure and 4 cases with bone fractures. The skin defect area ranged from 6 cm×5 cm to 12 cm×10 cm. The harvested flap area ranged from 7 cm×6 cm to 13 cm× 11 cm. The skin sensation was reconstructed by cutaneous neurorrhaphy. Results Postoperative follow-up ranged from 6 to 24 months with an average of 12 months. Partial flap necrosis occurred in 1 case and completely healed after dressing change. All the rest survived uneventfully. The two-point discrimination was 6 to 12 mm. Sensation recovery was satisfactory without physical discomfort. The texture of the flaps was close to normal skin with satisfactory appearance and wear resistance. The skin graft of donor site achieved primary healing without significant effect on walking. Conclusion The medial plantar flap has the advantages of larger cutting area, homologous anatomical structure and similar texture between foot and hand, and containing cutaneous nerve to reconstruct sensation. It is one of the ideal flaps for repair of palm and wrist large area skin defects.