足底内侧皮瓣在小腿及足踝皮肤软组织缺损修复中的应用

Application of medial plantar flap in the repair of skin and soft tissue defects in lower leg and ankle

目的足底内侧皮瓣对于小腿创面的修复鲜见报道。文中旨在研究足底内侧皮瓣转移修复小腿及足踝伴骨、肌腱外露皮肤软组织缺损创面的应用。方法回顾性分析2013年1月至2020年12月东部战区总医院烧伤整形科19例应用足底内侧皮瓣修复小腿和足踝部创面患者的临床资料。患者术前行多普勒超声、CTA或DSA检查,了解小腿血管情况,设计与受区缺损形状、面积相对应的足底内侧皮瓣。供瓣区即刻植皮修复,或移植真皮支架后二期植皮修复。术后随访皮瓣修复效果、供区愈合情况及足部感觉及功能恢复情况。结果所有患者皮瓣及移植皮片均一期成活。术后随访显示皮瓣外观较好,颜色、质地与周围皮肤相似,无明显臃肿,患者较满意。足底供区植皮外观较差,踇趾及第二趾感觉丧失。植皮后行走时足底的耐磨性良好。结论足底内侧皮瓣血供可靠、位置隐蔽、血管蒂长,切取后对足部外观和功能影响小,是修复小腿和足踝部中小面积皮肤软组织缺损的可行选择。

Objective There are few reports on the repair of lower leg wounds with medial plantar flap.The purpose of this paper is to study the application of medial plantar flap in repairing skin and soft tissue defects in lower leg and ankle with bone and tendon exposure.Methods 19 patients with skin and soft tissue defects in the lower leg and ankle that were repaired by the medial plantar flap in the Department of Burns and Plastic Surgery,Eastern Theater Command General Hospital from January 2013 to December 2020 were included in this study.Ultrasound,CTA and/or DSA examination were given to the patients before the surgery to determine the condition of blood vessels in lower leg.The medial plantar flap was designed according to the position,shape and area of the defects in the recipient area.The flap donor area was immediately repaired by skin grafts or temporarily covered by artificial dermis and repaired secondarily.The survival of the flap,the healing of the donor site,and the recovery of sensory and motor function were followed up for evaluation of therapeutic effect.Results The flaps and skin grafts of all patients survived in stage one.Postoperative follow-up showed that the appearance of the flap was good,the color and texture of the flap were similar to those of the surrounding skin,and the patients were satisfied.The appearance of skin graft in plantar donor area was poor,and the sensation of metacarpophalangeal and second toe was lost.The plantar wear resistance is good when walking after skin grafting.Conclusion The medial plantar skin flap has reliable blood supply,concealed position and long vascular pedicle,and has little effect on the appearance and function of the foot.It is a feasible choice to repair small and medium-sized skin and soft tissue defects of the lower leg and ankle.