含神经的游离足底内侧皮瓣修复小儿足跟软组织缺损  

Repair of heel soft tissue defect in children with free medial plantar flap with nerve

作　　者：杨学林[1] 刘春 胡福兴[1] 王强[1] Yang Xuelin;Liu Chun;Hu Fuxing;Wang Qiang(Department of Burn and Plastic Surgery,No.89 Hospital of PLA,Weifang 261021,China;Department of General Surgery,Weifang Municipal Hospital,Weifang 261021,China)

机构地区：[1]解放军第八十九医院烧伤整形科,潍坊261021 [2]潍坊市市立医院普通外科,261021

出　　处：《中华整形外科杂志》2021年第11期1251-1255,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨采用含足底内侧神经皮支的健侧游离足底内侧皮瓣,修复小儿足跟部皮肤软组织缺损的效果。方法回顾性分析2014年7月至2019年2月解放军第八十九医院收治的足跟部皮肤软组织缺损患儿的临床资料,均于健侧设计切取含足底内侧神经皮支的游离足底内侧皮瓣修复足跟部软组织缺损,腹股沟处取全厚皮覆盖供区创面,取皮处直接缝合。观察术后皮瓣的外观、质地、颜色等指标及术后2年皮瓣感觉恢复情况,根据美国足踝外科协会评估标准评价患足术后的功能恢复情况。结果共选择6例足跟部皮肤软组织缺损患儿,男4例,女2例,年龄3~13岁;右侧4例,左侧2例;皮肤软组织缺损范围2 cm×3 cm~6 cm×7 cm。本组6例皮瓣全部成活,植皮区均一期愈合,皮瓣切取面积3 cm×4 cm~7 cm×8 cm。随访2~3年,皮瓣外观无臃肿,色泽、质地与周围组织近似,蒂部平整。皮瓣两点辨距觉5~10 mm,平均7 mm。健侧足部供区植皮处仅留有色素沉着,未见明显瘢痕,患足及健足负重行走功能无影响,踝关节功能依照美国足踝外科协会评估标准评价:优4例,良2例。结论含足底内侧神经皮支的健侧游离足底内侧皮瓣与足跟部组织近似,血供可靠,不损伤主要血管,移植后感觉恢复较好,是修复小儿足跟软组织缺损的理想皮瓣。Objective To explore the method and clinical effect of the free medial plantar flap with the nerve in the reconstruction of skin and soft tissue defect of heel in children.Methods A series of retrospective analyses was conducted on the cases with heel skin and soft tissue defects admitted to the 89th Hospital of the PLA from July 2014 to February 2019.The medial plantar skin flap with cutaneous branches of the medial plantar nerve was harvested from the healthy side and transferred to the opposite side to repair the soft tissue defect of the heel of children.Then,the free skin graft was taken from the groin area to cover the donor site,and the wound was sutured directly.The appearance,texture,and color of the flap were observed,and the sensory recovery of the flap was evaluated two years after the operation.The functional condition was elevated by the American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot function scoring system.Results A total of 6 children with heel skin and soft tissue defects were enrolled,including 4 males and 2 females,aged from 3 to 13 years.There were 4 cases on the right,and 2 cases on the left side,the size of skin and soft tissue defect was 2 cm×3 cm-6 cm×7 cm.All 6 flaps survived,the skin graft area healed in one stage,and the size of the flap was 3 cm×4 cm-7 cm×8 cm.The patients were followed up for 2-3 years.The appearance of the flap was not bloated,the color and texture of the flap were similar to the surrounding tissue,and the pedicle was flat.The two-point discrimination of the flap was 5-10 mm,with an average of 7 mm.There were only pigmentation and no obvious scar in the donor site of the uninjured foot.The ankle joint function was evaluated according to the American Association of foot and ankle surgery:4 cases were excellent and 2 cases were good.Conclusions The free medial plantar flap with the nerve is similar to the heel tissue,with reliable blood supply,no damage to the main blood vessels,and good sensory recovery after transplantation.It is an ideal fla

关 键 词：外科皮瓣 神经 足底内侧皮瓣 足跟部 小儿 修复 

分 类 号：R726.2[医药卫生—儿科]