保留跖腱膜表面筋膜组织的足底内侧薄皮瓣修复手足部皮肤缺损

Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet

目的探讨保留跖腱膜表面筋膜组织的足底内侧薄皮瓣修复手足部皮肤缺损的可行性和疗效。方法2017年7月—2023年1月,应用保留跖腱膜表面筋膜组织的足底内侧薄皮瓣修复35例手足部皮肤缺损,其中选择带蒂皮瓣13例、游离皮瓣22例。男18例,女17例;年龄8~56岁,平均38.8岁。外伤导致缺损30例,受伤至入院时间2~6 h,平均3.3 h;溃疡创面3例,病程3.0、3.8、7.0个月;恶性黑色素瘤2例。创面部位:手指8例,手掌13例,足跟12例,足远端2例。皮肤缺损范围为4.0 cm×3.5 cm~12.0 cm×10.0 cm。皮瓣切取范围为5.0 cm×4.5 cm~13.0 cm×11.0 cm。足部供区均游离植皮修复。结果术后皮瓣均成活,创面Ⅰ期愈合。供区1例植皮边缘部分坏死,经换药后愈合;其余患者植皮均顺利成活。患者均获随访,随访时间6~24个月,平均18个月。皮瓣色泽、厚度和受区周围正常皮肤相近,术后6个月皮瓣两点辨别觉为7~10 mm,平均8 mm。供区未出现痛性瘢痕及感觉异常,足踝部功能良好,行走步态正常。结论应用保留跖腱膜表面筋膜组织的足底内侧薄皮瓣修复手足部皮肤缺损具有皮瓣外形好、足部供区植皮成活率高且并发症少等优点,是一种较理想的术式。

Objective To explore the feasibility and effectiveness of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet.Methods Between July 2017 and January 2023,35 cases of hand and foot defects were repaired with plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue(13 pedicled flaps and 22 free flaps).There were 18 males and 17 females,with an average age of 38.8 years(range,8-56 years).Thirty cases of defects were caused by trauma,and the interval between injury and admission ranged from 2 to 6 hours(mean,3.3 hours).Three cases were ulcer wounds with a course of 3.0,3.8,and 7.0 months,respectively.Two cases were malignant melanoma.Eight cases of wounds located in the fingers,13 cases in the palm,12 cases in the heel,and 2 cases in the distal foot.The size of skin defects ranged from 4.0 cm×3.5 cm to 12.0 cm×10.0 cm,and the size of flap ranged from 5.0 cm×4.5 cm to 13.0 cm×11.0 cm.The donor sites were repaired with skin grafts.Results All flaps were survived and the wounds healed by first intention after operation.The partial necrosis at the edge of the skin graft occurred in 1 case,which healed after dressing change;the other skin grafts survived successfully.All patients were followed up 6-24 months(mean,18 months).The flaps exhibited similar color and thickness to the surrounding hand and foot skin.Two-point discrimination ranged from 7 to 10 mm in the flaps with an average of 8 mm.The donor sites had no painful scars or sensory abnormalities.Foot and ankle functions were good and gaits were normal.Conclusion Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet had good flap shape,high survival rate of skin graft at the donor site,and no obvious complications.