股部交腿扩张皮瓣技术在修复全足底大面积软组织缺损中的应用

Repair of large-area soft tissue defect of the whole plantar using expanded cross-leg thigh flap

目的探讨应用皮肤软组织扩张术与大腿交腿皮瓣相结合修复足底大面积软组织缺损、改善足底站立负重功能的临床技术和方法。方法2015年2月至2019年6月,北京丰台右安门医院烧伤整形科采用健侧大腿扩张的交腿皮瓣修复足底软组织缺损患者8例,男5例,女3例,年龄16~56岁,平均31岁。右足4例,左足3例,双足1例。瘢痕溃疡4例,贴骨性瘢痕4例,骨外露1例。病变区清创后皮肤软组织缺损面积9 cm×16 cm^12 cm×29 cm,扩张皮瓣获取面积11 cm×18 cm^14 cm×30 cm,全部皮瓣均以带蒂方式交腿固定,1个月后断蒂。结果本组8例9个转移皮瓣,全部成活;1例皮瓣远端部分坏死,经二次扩张皮瓣修复。供瓣区均线性瘢痕一期愈合。均获6~24个月随访,足底皮瓣形态良好,均能负重行走,无破溃;术后12个月逐渐恢复保护性感觉和触觉。结论采用健侧大腿扩张交腿皮瓣,不但能修复全足底皮肤缺损,且能提供足够厚度软组织,增加足底负重耐磨功能。在穿支皮瓣及游离皮瓣转移受限情况下,扩张交腿皮瓣是修复足底大面积软组织缺损的一种较好的替代方法。

Objective To explore the clinical technique and method of reconstruction large soft tissue defect of plantar by skin soft tissue dilatation combined with thigh cross leg flap to improve the weight-bearing function of plantar standing.Methods From February 2015 to June 2019,8 cases with plantar soft tissue defects were repaired with cross leg flap expanded from the healthy side of the thigh.Right foot in 4 cases,left foot in 3 cases and bilateral in 1 case.There were 5 males and 3 females.Ages ranged from 16 to 56,with an average age of 31.Clinical features:scar ulcer in 4 cases,bone-sticking scar in 4 cases,bone exposure in 1 case.After debridement,the area of skin and soft tissue defect was 9 cm×16 cm-12 cm×29 cm,the area of harvest expanded flap was 11 cm×18 cm-14 cm×30 cm.All flaps were fixed by cross-leg with pedicle.The pedicle division were performed one month after the skin flap transmission.Results Of the 9 flaps transferred,8 survived,1 died in the distal part of the flap and was repaired by secondary expanded flap,and the donor site healed in linear scar stage.After 6-24 months follow-up,the plantar flap was in good shape and could walk with weight-bearing,without ulceration,and the protective tactile sensation was gradually restored in 12 months.Conclusions The large-area soft tissue defect of plantar was repaired with the expanded cross leg flap in the healthy thigh,which also provide sufficient thickness of soft tissue to increase the ability of bearing weight and wearing resistance of the sole.It is a good alternative method to repair large area soft tissue defect of plantar under the condition of limited transfer of perforator flap and free flap.