逆行足底内侧动脉蒂足内侧岛状皮瓣修复前足底皮肤缺损

目的 报道逆行足底内侧动脉蒂足内侧岛状皮瓣修复前足底皮肤缺损的手术方法及临床效果。方法 在解剖学研究基础上利用足底内侧动脉终末支与足底外侧动脉,第一跖骨背动脉及足底深支的吻合设计逆行足内侧岛状皮瓣修复前足底皮肤缺损创面,通过吻合皮下静脉静脉回流。结果 临床应用4例,皮瓣全部成活,随访6－24个月,外形与功能改善满意。结论 逆行足底内侧动脉蒂足内侧岛状皮瓣是修复前足底皮肤缺损的最佳选择之一。     

不同穿支蒂足(底)内侧逆行岛状皮瓣修复前足底软组织缺损

目的 介绍不同穿支蒂足(底)内侧逆行岛状皮瓣修复前足底软组织缺损的临床经验.方法 对前足底不同部位软组织缺损8例,采用不同穿支蒂足内侧或足底内侧逆行岛状皮瓣修复:对4例前足底内侧软组织缺损,采用以足底内侧浅支在第一跖骨颈的穿支为蒂的足内侧逆行岛状皮瓣修复;对2例前足底中部软组织,采用足底内侧动脉深支或足背动脉足底深支的穿支为蒂的足底内侧逆行岛状皮瓣修复;对2例前足底外侧软组织缺损采用足底外侧终末穿支或足底动脉的穿支为蒂的足底内侧逆行岛状皮瓣修复.结果 术后7例皮瓣顺利成活,1例皮瓣术后部分坏死,将坏死皮瓣清除后经扩创,肉芽生长良好后,取髂腰部带真皮下血管网皮肤植皮.有5例患者经4～6个月随访,皮瓣血供良好,外观满意,感觉恢复至6～8mm,恢复正常行走功能;另3例失访.结论 采用不同穿支蒂足内侧或足底内侧逆行岛状皮瓣是修复前足底不同部位软组织缺损的好方法.     

足底内侧动脉逆行岛状皮瓣修复前足底皮肤缺损

目的:探讨应用足底内侧动脉逆行岛状皮瓣修复前足底皮肤缺损的临床应用效果。方法:回顾性研究分析2014年-2015年我科设计足底内侧动脉逆行岛状皮瓣修复5例前足底创面的临床资料。结果:临床应用5例,皮瓣切取范围2cm×2cm~3cm×4cm,供瓣区全厚植皮皮瓣及植皮全部成活,随访1个月~6个月,皮瓣外观、血运良好,质韧耐磨,无溃疡现象。结论:足底内侧动脉逆行岛状皮瓣具有操作简单、成功率高且皮瓣耐磨,与受区皮肤质地、色泽比较接近等优点,是修复前足底皮肤软组织缺损较理想的选择。     

足内侧岛状皮瓣逆行转位修复足前部皮肤缺损的解剖与临床应用

目的 探讨足内侧岛状皮瓣逆行转位修复足前部皮肤缺损的术式.方法 48侧成尸足标本经动脉灌注红色乳胶,5侧新鲜足标本动脉造影,观测躅横动脉、第一跖底动脉、足底内侧动脉深支的外径、分布及其之间的吻合,并对躅趾底内侧动脉浅支进行分型,观察足内侧皮瓣内的动脉吻合和分布范围.临床上应用足内侧逆行岛状皮瓣修复足前部皮肤缺损12例,男11例,女1例;年龄12～54岁,平均32岁.皮肤缺损面积2.5 cm×3.5 cm～7.5 cm×9.5 cm.结果 <足母>横动脉与躅趾胫侧趾底固有动脉、<足母>趾腓侧趾底固有动脉、第一跖底动脉远侧段吻合形成动脉环.<足母>展肌上缘动脉弓和足底内侧动脉深支内侧支在<足母>展肌表面形成动脉网.临床上采用足内侧逆行岛状皮瓣修复足前部皮肤缺损12例均获得成功.皮瓣切取面积3 cm×4 cm～8 cm×10 cm.全部病例随访1～3年,平均2年,皮瓣全部成活,无破溃、臃肿,足、踝部功能正常,足部血供佳.结论 足内侧岛状皮瓣逆行转位修复足前部皮肤缺损,皮瓣旋转点最远可前移至<足母>趾近节趾中点,皮瓣切取面积大、血供好、手术方式简便、切取后对足部血供影响较小,是修复足前部皮肤缺损的理想皮瓣.     

改良逆行足底内侧动脉浅支岛状皮瓣移位修复前足创面

目的:报道以改良足底内侧动脉浅支皮瓣逆行修复前足皮肤软组织缺损、骨外露、肌腱外露等创面的效果.方法:改良足底内侧动脉浅支岛状皮瓣逆行移位修复前足创面9例,皮瓣面积4cm×5cm～7cm×9cm.结果皮瓣全部成活,随访6～12个月,皮瓣色泽基本正常,耐磨,弹性好,未出现皮瓣坏死及皮瓣摩擦破损,供皮区游离植皮完全成活.结论:改良足底内侧动脉浅支逆行岛状皮瓣治疗前足皮肤软组织缺损创面具有切取方便、手术简捷、创伤小,皮瓣血供可靠、不影响足部血运等优点,可满足前足中小面积创面修复需要.     

足底内侧逆行岛状皮瓣在修复足底前部创面的应用

目的 探讨足底前部及趾腹创面的修复方法。方法 采用足底内侧逆行岛状皮瓣移位修复足底前部、趾腹创面，皮瓣的神经与创面的神经吻合重建皮瓣感觉，足底内侧静脉与创面皮下静脉吻合以改善皮瓣血液回流。结果 临床应用8例，修复足底前部创面6例，修复足底前部及趾腹创面2例，皮瓣全部成活，随访3个月～2年10个月，皮瓣外形满意，质韧耐磨，无溃疡现象，感觉良好，两点辨别觉8～12mm，足及足趾活动功能良好。结论 足底内侧逆行岛状皮瓣是修复足底前部及趾腹创面的良好方法。     

足底内侧动脉皮穿支蒂岛状皮瓣修复前足皮肤缺损

目的总结逆行足底内侧动脉皮穿支蒂岛状皮瓣修复前足皮肤缺损的临床效果。方法2004年8月至2007年5月采用足底内侧动脉皮穿支蒂岛状皮瓣修复前足皮肤软组织缺损创面，临床应用7例，皮瓣面积为9cm×6cm～7cm×5cm，修复受区创面大小为8cm×5cm～6cm×5cm。结果术后皮瓣全部成活，随访3～35个月，皮瓣质地良好，外形不臃肿，供区愈合良好。结论足底内侧动脉皮穿支蒂岛状皮瓣血运可靠，设计灵活，手术切取简便安全，是修复前足皮肤软组织缺损创面的理想方法。     

足底内侧动脉岛状皮瓣修复足跟部皮肤缺损

目的：探讨采用足底内侧动脉岛状皮瓣治疗足跟部皮肤缺损的，临床效果。方法：采用足底内侧动脉岛状皮瓣治疗10例足跟部皮肤缺损患者。结果：本组皮瓣完全成活9例，1例皮瓣远端部分组织坏死，经换药后愈合良好。结论：足底内侧动脉岛状皮瓣修复足跟部皮肤缺损，组织与足跟相似，可满足负重行走的功能需要。切取操作简单，切取后对足部负重功能及外观影响很小，是修复足跟部组织缺损的良好方法。     

应用小腿内侧逆行岛状皮瓣修复足底皮肤缺损

应用小腿内侧逆行岛状皮瓣修复足底皮肤缺损谢晓勇，李平生１９９０～１９９５年１月，我院应用小腿内侧逆行岛状皮瓣移植，修复足底皮肤缺损１０例，均获成功。随访６个月～２年，外形及功能均满意，报道如下。临床资料本组男８例，女２例，年龄１５～４８岁。皮肤缺损均...     

足底深支为蒂踝前逆行岛状皮瓣临床应用

目的：为解决前足皮肤缺损临床修复棘手的难题。方法：用３例成年男性新鲜尸体注入红色乳胶以观察足背动脉的分支，在解剖研究的基础上，７例前足皮肤缺损的病例采用以足底深支为蒂的逆行岛状皮瓣修复。结果：足背动脉在踝关节前方有１～２支恒定的皮支，称之为踝前皮支，测量该皮支口径０．４～０．６ｍｍ。７例前足皮肤缺损病例以足底深支为蒂踝前逆行岛状皮瓣治疗效果满意。结论：以足底深支为底的皮瓣可以解决前足皮肤缺损的问题。     

Long Term Outcomes of Split-Thickness Skin Grafting to the Plantar Foot

The most common consequence of neuropathy is a diabetic foot ulcer, which usually occurs on the plantar surface of the foot. Split-thickness skin grafting (STSG) has been shown in numerous studies to be an effective treatment for rapid coverage of diabetic ulcers. The purpose of this study is to retrospectively examine the outcomes of STSG to the plantar foot and determine the durability of this treatment compared to non–plantar surface STSG. This is a retrospective, single-center, institutional review board approved, case-control study of all patients who received STSG to their lower extremity for chronic ulcers from November 2013 to February 2017. Patients with ulcers on the plantar surface were considered cases, and non–plantar surface ulcers were considered controls. There were 182 patients who received STSG to the lower extremity, 52 to the plantar surface foot and 130 to non–plantar surface locations. Healing at 30 days was not significantly different between plantar and nonplantar ulcers (19% versus 28%, p = .199) but did become significant at 60, 90, and 365 days (21% versus 45%, p = .003; 33% versus 49%, p = .043; 38% versus 64%, p = .002, respectively). However, time to full healing was not significantly different between plantar and nonplantar groups (18.2 ± 19.5 versus 17.4 ± 21.6 weeks, mean ± standard deviation, p = .84). Recurrence was low for both groups (17% versus 10%, respectively), and there was no significant difference between groups (p = .17). Patients with plantar surface ulcers can achieve a durable coverage/closure of their wounds with STSG. When combined with appropriate patient selection and postoperative offloading, acceptable recurrence rates can be achieved.     

Plantar fasciitis

INTRODUCTION

In this article we look at the aetiology of plantar fasciitis, the other common differentials for heel pain and the evidence available to support each of the major management options. We also review the literature and discuss the condition.

METHODS

A literature search was performed using PubMed and MEDLINE®. The following keywords were used, singly or in combination: ‘plantar fasciitis’, ‘plantar heel pain’, ‘heel spur’. To maximise the search, backward chaining of reference lists from retrieved papers was also undertaken.

FINDINGS

Plantar fasciitis is a common and often disabling condition. Because the natural history of plantar fasciitis is not understood, it is difficult to distinguish between those patients who recover spontaneously and those who respond to formal treatment. Surgical release of the plantar fascia is effective in the small proportion of patients who do not respond to conservative measures. New techniques such as endoscopic plantar release and extracorporeal shockwave therapy may have a role but the limited availability of equipment and skills means that most patients will continue to be treated by more traditional techniques.     

Plantar fibromatosis

Plantar fibromatosis is defined as a benign fibrous disorder involving the plantar aponeurosis. Although its incidence is well described on the hands, it is less commonly seen on the feet, and its etiology is unknown. A differential diagnosis for the heel pain along the medial arch could be a benign thickening of the plantar fascia associated with plantar fibromatosis. Its high recurrence after surgical excision and problematic scarring and wound presents a significant challenge to the reconstructive foot and ankle surgeon. This article reviews the history, clinical presentation, pathologic findings, and surgical approaches to the treatment of plantar fibromatosis.