足底内侧皮瓣串联股前外侧穿支皮瓣移植修复足跟及周围软组织缺损

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目的:探讨应用足底内侧皮瓣串联股前外侧穿支皮瓣(ALTP)移植修复足跟及周围软组织缺损的临床疗效。方法:2017年7月至2019年6月,共收治足跟及周围软组织缺损共7例,男5例,女2例,创面软组织缺损大小10.0 cm×15.0 cm~15.0 cm×22.0 cm,均采用足底内侧皮瓣串联ALTP移植修复,其余创面植皮覆盖。供区直接缝合或植皮覆盖。术后定期随访,观察皮瓣成活、外观等,并评估临床效果。结果:术后创面均I期愈合,未出现感染、血管危象、坏死。术后7例均得到有效随访,随访时间6~18(平均12)个月,游离皮瓣及游离植皮均成活,外观良好并无明显臃肿,皮瓣局部未见血肿水泡、磨损、溃疡,质地柔软,弹性较好。术后1年复查,均能不扶拐行走2 km以上,未出现足跟部疼痛不适(跟骨骨折患者除外),未见足底皮瓣血肿、磨损、溃疡。结论:足底内侧皮瓣串联ALTP修复足跟及周围软组织缺损,是一种重建足跟部功能的有效方法,修复后的足跟具备良好的耐磨性且外形美观。“,”Objective:To explore the clinical effect of plantar medial flap combined with anterolateral thigh perforator flap (ALTP) in repairing the soft tissue defect of heel and surrounding.Methods:From July, 2017 to June, 2019, a total of 7 patients with soft tissue defect at heel and its surrounding were treated, including 5 males and 2 females. The wound area was 10.0 cm×15.0 cm-15.0 cm×22.0 cm. Medial plantar flap and ALTP were combined in tandem to repair the heel wound. The remaining wounds were covered by skin grafting. The donor area was directly sutured or covered with skin graft. Followed-up was conducted to observe the survival and appearance of the flap and to evaluate the therapuetic effect.Results:All wounds healed primarily without infection, vascular crisis nor necrosis. All patients were followed-up for 6-18 (averaged of 12) months. Both the free flap and skin graft survived well with good appearance and without obvious swelling. No hematoma blisters, abrasion and ulcers occoured. The flaps were soft with good elasticity. At the 1 year postoperative review, patients were able to walk more than 2 kilometers without crutches. No heel pain and discomfort occurred (except for the patients with calcaneal fractures). Hematoma, abrasion, and ulcers of the plantar flap were not found.Conclusion:It is an effective method to repair the soft tissue defect of the heel and its surrounding by transfering the medial plantar flap in tandem with the ALTP. The repaired heel was in good shape with good function.
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倪文东1957年生,陕西黄陵人。1982年毕业于西北大学中文系。中国书协第四届学术委员,北京师范大学艺术与传媒学院书法系教授、博士生导师,京师印社社长。多年从事书法教学、
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