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  

Repair soft tissue defect of heel and surrounding by plantar medial flap combined with anterolateral thigh perforator flap

作　　者：吕乾 朱跃良 浦绍全 赵泽雨 陈汉芬 徐永清 LYU Qian;ZHU Yueliang;PU Shaoquan;ZHAO Zeyu;CHEN Hanfen;XU Yongqing(Institute of Orthopaedics,920 Hospital,The Joint Logistic Service of Chinese People's Liberation Army,Kunming 650032,China)

机构地区：[1]中国人民解放军联勤保障部队第九二○医院,全军创伤骨科研究所,昆明650032

出　　处：《中华显微外科杂志》2020年第6期549-552,共4页Chinese Journal of Microsurgery

基　　金：云南省创伤骨科临床医学中心建设项目(ZX20191001)。

摘　　要：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.

关 键 词：足底内侧皮瓣 股前外侧穿支皮瓣 串联皮瓣 足跟 修复 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]