摘要
目的探讨应用游离足底内侧皮瓣(MPF)串联股前外侧皮瓣(ALTF)修复足底负重区大面积软组织缺损的手术方法及临床疗效。方法 2017年4月至2019年8月,采用游离MPF串联ALTF修复足底负重区大面积软组织缺损8例,创面累及后足及周围4例,前足及周围3例,全足1例,其中串联皮瓣修复足跟5例,修复前足跖底3例。创面缺损面积15.0 cm×10.0 cm~26.0 cm×22.0 cm;切取MPF面积为6.0 cm×5.0 cm~8.0 cm×6.5 cm,供区均采用全厚皮片移植修复;ALTF面积15.0 cm×7.0 cm~27.0 cm×11.0 cm,供区2例直接拉拢缝合,6例取腹部全厚皮片移植修复。术后通过门诊、微信随访。结果本组8例串联皮瓣及供区植皮均成活,仅有1例ALTF出现远端皮缘坏死,经换药后痂下愈合。术后8例均获得随访9~18个月,皮瓣弹性可,质地良好,MPF均恢复痛、触觉,ALTF恢复部分触觉,负重、行走功能良好。末次随访均采用Maryland足功能评分标准评价,结果优4例,良3例,可1例。结论采用游离MPF串联ALTF对足底负重区大面积软组织缺损进行针对性修复,可很好的恢复足部负重、行走功能,临床效果良好,是理想的修复方法之一。
Objective To investigate the surgical method and clinical effect of free medial plantar flap(MPF)combined with anterolateral thigh flap(ALTF)in repair of large soft tissue defect in the weight bearing area of sole.Methods From April,2017 to August,2019,8 patients with large soft tissue defects in plantar weight bearing area were repaired by free MPF combined with ALTF.Four patients had the defects located in the hindfoot and the surrounding area,3 in the forefoot and 1 in the whole foot.A tandem flap made of free MPF combined with ALTF was used to repair the heel in 5 patients and repair the plantar forefoot in 3 patients.The size of defects ranged from 15.0 cm×1O.O cm to 26.0 cm×22.0 cm.The size of the MPF ranged from 6.0 cmx5.0 cm to 8.0 cm×6.5 cm.The donor sites repaired with full thickness skin graft.The size of ALTF ranged from 15.0 cm×7.0 cm to 27.0 cm×11.O cm.Two donor sites were sutured directly,and the other 6 were repaired by full-thickness abdominal skin graft.The patients entered follow-up at outpatient clinic and via WeChat for 9 to 18 months.Results All the 8 tandem flaps and the donor grafts survived.Only 1 ALTF had a distal necrosis and healed after change of dressing.All the flaps had good elasticity and good texture.All the recipient area of MPF achieved sensation recovery of pain and touch.But the ALTF only partially recovered tactile sensation.The weight-bearing and walking function were good.At the last follow-up,all patients were evaluated by Maryland foot score,of which 4 patients were excellent,3 were good,and 1 was fair.Conclusion The free MPF combined with ALTF is one of the ideal methods for the repair of plantar soft tissue defect in the weight bearing area of sole.It can better restore the foot weight-bearing and walking function with good clinical effect.
作者
杨涛
熊颖杰
胡智玉
周树萍
张凯
陈佳
周明武
幸超峰
YANG Tao;XIONG Yingjie;HU Zhiyu;ZHOU Shuping;ZHANG Kai;CHEN Jia;ZHOU Mingwu;XING Chaofeng(Department of Trauma and Microsurgery,988 Hospital of Joint Logistic Support Force,PLA,Zhengzhou 450042,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2021年第4期398-402,共5页
Chinese Journal of Microsurgery
基金
河南省医学科技攻关计划联合共建项目(LHGJ20200793)。
关键词
足底内侧皮瓣
股前外侧皮瓣
足底
软组织缺损
修复
Medial plantar flap
Anterolateral thigh flap
Sole of foot
Soft tissue defect
Repair
