作者： Jonas Löfstrand;Chih-Hung Lin MD*
文章出處： Annals of Plastic Surgery. 80(3):245–251, MARCH 2018
摘要：
一、背景：足跟負重處或前足的缺陷通常來自慢性傷口，急性創傷或腫瘤切除。這種缺陷的重建對於提供穩定，耐用和感覺的皮瓣有更大的要求。現今技術提出了幾種用於重建足底缺損的皮瓣，但通常此種重建方式常見傷口複發性潰瘍或需要額外的手術去補足加強。本文提供了受神經支配的足底內側足底皮瓣修復負重性足底缺損的方法和結果。
二、方法：對1999年至2016年間接受過神經支配游離內側足底皮瓣治療的負重足跟及前足缺陷的17名患者進行了圖表調查。
11名患者為男性，6名患者為女性，平均年齡為29.5歲（患者年齡範圍為4-52歲）。一例是足跟及前足缺損、7例是足跟缺損、9例是前足缺損。適應症為急性創傷，創傷後繼發性重建和腫瘤切除。結果：平均缺損面積為8.0±5.4 cm×5.1±2.1 cm，平均皮瓣尺寸為9.7±1.4 cm×6.4±0.9 cm。其中一例個案手術皮瓣患有動脈血栓形成，需要再次手術並進行搶救；其餘的患者，術後恢復良好，平均觀察追蹤時間為59.3（±51.3.6）個月。
術後兩名患者因角化過度和增生性瘢痕而接受了輕微的皮瓣矯正，2名患者由於部分皮膚移植缺失而需要進行供體部位矯正。一名患者因轉移性疾病在1年內死亡。
所有追蹤1年以上（n = 15）的患者均表示觸碰皮瓣時有感覺，10名患者接受了兩點分辨距與辨識能力測試，沒有患者復發潰瘍。
結論：神經支配內側足底皮瓣是治療負重足跟或前足中大缺陷的理想解決方案。它提供了穩定，耐用和感覺敏感的皮瓣。長期結果良好，在觀察追蹤期間沒有患者因複發性潰瘍而備感辛苦。
Abstract
BACKGROUND:
Defects in the weight-bearing heel or forefoot are commonly derived from chronic wounds, acute trauma, or tumor excision. Reconstruction of such defects pose a significant challenge to provide a flap that is stable, durable, and sensate. Several flaps have been described for reconstruction of plantar defects, but recurrent ulcerations and/or the need of additional procedures are common. This article provides the approach and outcomes of innervated free medial plantar flap for weight-bearing plantar defects reconstruction.
METHODS:
Chart review was performed of 17 consecutive patients with defects in the weight-bearing heel and/or forefoot who were treated with innervated free medial plantar flaps between the years 1999 and 2016. Eleven patients were male, and 6 patients were female. The mean age was 29.5 years (range, 4-52 years). One case was combined heel/forefoot defect, 7 were heel defects, and 9 were forefoot defects. Indications were acute trauma, secondary reconstruction after trauma, and tumor excision.
RESULTS:
The mean defect size was 8.0 ± 5.4 cm × 5.1 ± 2.1 cm, and mean flap size was 9.7 ± 1.4 cm × 6.4 ± 0.9 cm. One flap suffered from arterial thrombosis, which necessitated reoperation, and was salvaged. For the remaining cases, the postoperative course was uneventful. The mean follow-up time was 59.3 (±51.3.6) months. Two patients received minor flap corrections due to hyperkeratosis and hypertrophic scar, and 2 patients required donor site correction owing to partial loss of skin graft. One patient succumbed within 1 year owing to metastatic disease. All patients that were followed more than 1 year (n = 15) could sense blunt touch of the flap. Ten patients underwent 2-point discrimination test. No patient had recurrence of ulceration.
CONCLUSIONS:
The innervated medial plantar flap is an excellent solution for treatment of medium-to-large defects in the weight-bearing heel or forefoot. It provides glabrous skin that is stable, durable, and sensate. The long-term results are good, with no patient afflicted by recurrent ulceration during the follow-up time.
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