足跟部皮肤恶性肿瘤切除术后软组织缺损的显微外科修复

目的：探讨足跟部皮肤恶性肿瘤的手术切除和修复重建的原则。方法：对9例足跟部恶性黑色素瘤、鳞状细胞癌和慢性溃疡恶变行局部广泛切除，根据足跟部软组织缺损的大小，分别选用足外侧皮瓣、足底内侧皮瓣、腓肠神经营养血管逆行皮瓣及内踝上皮瓣转移修复。结果：9例皮瓣全部成活，在功能及感觉恢复方面，足底内侧皮瓣与足外侧皮瓣最佳，腓肠神经营养血管逆行皮瓣恢复良好，内踝上皮瓣效果稍差，没有感觉。结论：足跟部皮肤恶性肿瘤应行局部广泛切除术，在切缘阴性的基础上进行修复重建，根据创面大小分别采用足外侧皮瓣、足底内侧皮瓣及腓肠神经营养血管逆行皮瓣，临床疗效满意。

Microsurgical reparation of soft tissue defect of heel after resection of skin malignant tumor

Objective:To investigate the surgical resection and reparation of skin malignant tumor of the heel. Methods:Local extensive resection was performed in 9 patients with heel malignant tumors, including malignant melanoma, squamous cell carcinoma, and chronic ulceration with malignant change. Lateral pedal skin flap, plantar medial artery island skin flap, retrograde skin flap supplied by sural nutrition blood vessel, and superior medial ankle skin flap were respectively applied in the reparation according to the size of heel soft tissue defect. Results:The surgical reparation was successful in all 9 cases. Considering the recovery of the function and sensation, the best result was acquired with plantar medial artery island skin flap and lateral pedal skin flap, good with retrograde skin flap supplied by sural nutrition blood vessel, and not good with superior medial ankle skin flap. Conclusion:Local extensive resection is essential for the skin malignant tumors of the heel. Reparative reconstruction should be made on negative operative margin. Satisfactory clinical outcome is achieved by using lateral pedal skin flap, plantar medial artery island skin flap, and retrograde skin flap supplied by sural nutrition blood vessel.