OBJECTIVE To investigate the repairing method of soft tissue defect of heel, pedicled island myocutaneous flap of flexor digitorum brevis was designed. METHODS From 1984 to 1997, 26 cases with soft tissue defect of heel were adopted in the clinical trial. Among them, the were 18 males, 8 females and the age ranged from 15 to 60 years old. The area of wound ranged from 2.5 cm x 1.5 cm to 8.0 cm x 6.0 cm. RESULTS After operation, all of the flaps survived. They were followed up for 9 to 72 months. All of the flaps had primary healing except in one there was infection of peripheral of the flap. The contour of heel was satisfactory the sensation of flap was good and the weight-bearing function was also successful. CONCLUSION It was concluded that the myocutaneous flap of flexor digitorum brevis could be used to repair the soft tissue defect of heel because of its nearby position, hidden location, good recovery of skin sensation and weight-bearing function, Besides, the procedure of this operation was simple and the anti-inflammatory potential of the flap was high. However, Because of the limited donor area, the pre-operative design was important.
【摘要】 目的 探讨应用足底内侧动脉穿支蒂皮瓣修复足跟皮肤缺损的临床应用。 方法 1998年9月-2009年3月，应用此皮瓣修复足跟皮肤软组织缺损42例。术前对创面作充分准备，术中以术前彩色多普勒超声探测的足底内侧血管及穿支走向为轴心，根据需要设计皮瓣，沿皮瓣两侧向中间显露，在踇展肌与趾短屈肌之间解剖出足底内侧血管主干，显露动脉穿支及伴行神经。将血管向近端分离获得足够长度后，掀起皮瓣，切取完成并将皮瓣行明道转移修复创面。 结果 除2例术后4 d出现皮瓣远端部分坏死，经换药后愈合，其余40例皮瓣均全部成活。 结论 足底内侧动脉穿支蒂皮瓣是修复足跟软组织缺损的一种理想皮瓣。【Abstract】 Objective To study the clinical application of perforator artery flap of medial plantar in repairing skin defect of the heelstick. Methods From September 1998 to March 2009, skin defects of the heelstick of 42 patients were repaired with the perforator artery flap of medial plantar. Adequate preparations were given on the wound before operation. Based on the results of color Doppler ultrasound of the medial plantar vascellum before or during the operation, the flap was designed according to the size of the defect and transferred to repair the defect. Results All the flaps survived completely except two flaps were partial lynecrotic in the distal, which healed after change of dressing. Conclusion Perforating artery flap of medial plantar is an ideal way to repair skin defect of the heelstick.
Objective To explore the effect of transferring adjacent non-main vessel pedicle flap on repairing the heel skin defect. Methods From February 2000 to April 2004, 4 kinds of flaps with non-main vessel pedicle were used to repair 30 cases of heel skin defect. Of the 30 patients, 19 were male and 11 were female, whose ages ranged from 8 to 65. Among them, 19 cases were crush injury, 5 cases were press injury, 3 cases were electric saw injury, 2 cases were osteomyelitis, and 1 case was squamous cell carcinoma. Fourteen cases were with defect area ranged from 6.0 cm×5.5 cm to 16.5 cm×11.0 cm. All the 14 cases were repaired with distant pedicled sural vascular flap of nutrient vessels and saphenous vascular flap of nutrient vessels.The sizes of the dissected flap ranged from 6.0 cm×5.0 cm to 18.0 cm×12.0 cm. And the other 16 cases with defect area ranged from 2.5 cm×2.0 cm to 5.5 cm×4.5 cm were repaired with foot lateral flap and foot base medial flap.The sizes of the dissected flap ranged from 4.0 cm×3.0 cm to 8.0 cm×7.0 cm. Results All cases were followed up for 6 to 12 months. The flaps all survived with satisfactory appearance and no ulceration. Callus appeared in 2 cases.The sense of pain and touch was partly or completely restored. The two-point discrimination sense recovered to 1.0-3.2 cm. Conclusion As it is easilyaccessible, highly flexible and causes little damage to blood circulation, transferring adjacent non-main vessel pedicle flap is effective in repairing foot heel skin defect.
OBJECTIVE The repair of soft tissue defect of heel by traditional operation did not restore the sensation of the heel. METHODS In order to solve this problem, the saphenous neurovascular skin flap reinnervated by end-to-side neuro-anastomosis was designed and 3 male patients with soft tissue defects of the heel were so treated. Grossgraft of saphenous neurovascular skin flap was employed for repairing the soft tissue defects of heel and the pedicle was divided at 21 days after operation. The end-to-side neuro-anastomosis was used to reinnervate not only the skim flap, but also the skin area of the medial malleolus, medial aspect of the foot and the big toe of the donor limb. RESULTS After follow-up of 6-12 months, the walking and weight bearing functions of the affected limbs were good, the contour of the grafted area was satisfactory, and the recovery of sensation of the skin flap, the medial malleolus, the medial aspect of the foot and the big toe was observed. CONCLUSION 1. Crossgraft of the saphenous skin flap was an effective method to repair the soft tissue defect of the heel; 2. End-to-side neuro-anastomosis could restore the sensation of the skin flap.
Objective To discuss the surgery procedure and the cl inical effectiveness of repairing skin and soft tissue defects in the lateral foot and the heel with the abductor digiti minimi muscle flap. Methods Between July 2002 and October 2010, 8 patients with skin and soft tissue defects in the lateral foot and the heel were treated. There were 6 males and2 females with an average age of 42 years (range, 28-65 years). The locations were the left foot in 5 cases and the right foot in 3 cases. Defects were caused by ulcer of the heel in 2 cases, by poor heal ing of incision after calcaneus fracture surgery in 1 case, and by crushing in 5 cases. The defect size ranged from 1.5 cm × 1.0 cm to 8.0 cm × 2.6 cm. The disease duration was 30 minutes to 26 months. The result of bacterial culture was positive in 2 cases. After 9 to 15 days of debridement and dressing change, defects were repaired with the abductor digiti minimi muscle flap of 5.6 cm × 1.5 cm to 7.6 cm × 1.8 cm at size. The donor sites were sutured directly. Results Partial necrosis of muscle flap occurred in 1 case at 4 days after operation, which was cured by symptomatic treatment, and the other muscle flaps survived. All incisions of the donor sites healed by first intention. The muscle flaps survived and the granulation grew well at 9-21 days after operation, and the muscle flap wounds were repaired by free leg edge thickness skin grafting. Wounds were repaired by one-stage free skin grafting in 1 case and by two-stage free skin grafting in 7 cases; all skin flaps survived and wounds healed by first intention. Seven patients were followed up 9-18 months (mean, 11 months). The appearance, texture, and sensation were satisfactory. The two-point discrimination was 16-23 mm (mean, 19.5 mm). Epidermal abrasion occurred in 1 case of heel ulcer after weigt-bearing walking. Hallux valgus and muscle weakness occurred in 1 case of necrosis of the peroneus length tendons; and the satisfactory results were achieved in the other patients. Conclusion It has satisfactory effectiveness to use the abductor digiti minimi muscle flap for repairing skin and soft tissue defects in the lateral foot and the heel, which has the advantages of easy-to-operate, safe, less injury at donor site, goodappearance and texture, and good recovery of sensation.
Objective To investigate the clinical results of allograft and sural neurovascular flap in repairing calcaneus and skin defects.Methods From February 1996 to December 2002, allograft and sural neurovascular flap were used to repair calcaneusand skin defects in 6 cases. The causes included road accident in 3 cases, strangulation in 2 cases and crashing object in 1 case. The defect locations were at theback of the calcaneus( 1/3, 1/2 and 2/3 of calcaneus in 3 cases, 2 cases and 1case respectively). The flap area ranged from 6 cm×7 cm to 12 cm×17 cm. Results The flaps survived completely in 4 cases; the distal flaps necrosed partly in 2 cases and the wound healed by dressing. The postoperative X-ray films showed that the repaired bone and joint had normal position and the arcus plantaris recovered. After a follow upof 6 months to 3 years all the patients were achieved bone union in allograft and had no complications of absorption, infection and repulsion. The weightbearing and walking functions were restored and the injured foot obtained a satisfactory contour. After 36 months of operation, the sensory recovery of foot occurred. Conclusion The used-allograft iseasy to be obtained and arcus plantaris is easy to recover. The reversesural neurovascular- flap in repairing calcaneus and skin defects has the following advantages: the maintenance of blood supply for injured foot, the less dangerous operation, the simple procedure, the recovery of walking function, and the good appearance and sensation.
ObjectiveTo study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.MethodsBetween March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained.ResultsThe origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements (P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.ConclusionThe digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.