逆行足内侧动脉岛状皮瓣修复[足母]趾软组织缺损

目的探讨应用逆行足内侧动脉岛状皮瓣转移修复[足母]趾软组织缺损的临床疗效。方法2016年2月-2018年1月,应用逆行足内侧动脉岛状皮瓣转移修复[足母]趾软组织缺损27例。皮瓣面积平均3.0 cm×5.5 cm(2.0 cm×4.0 cm^4.0 cm×6.5 cm)。结果27例皮瓣全部成活,其中3例术后第3天皮瓣远端出现暗紫,经无菌换药、拆除蒂部部分缝线后成活。随访2~20个月,皮瓣颜色、外观均正常,质地满意,无臃肿及挛缩。结论应用逆行足内侧动脉岛状皮瓣转移修复[足母]趾软组织缺损,操作简单,对供区无明显影响,皮瓣耐磨程度好,外形满意,质地良好,是修复[足母]趾软组织缺损的优良方法。     

前足皮肤缺损的皮瓣修复

目的总结不同类型皮瓣修复前足部皮肤缺损的疗效。方法根据前足皮肤缺损的部位,采用不同类型的外科皮瓣修复50例,其中交腿皮瓣2例,带蒂逆行岛状皮瓣20例,吻合血管的游离皮瓣28例。结果除3例带蒂逆行岛状皮瓣远端部分坏死,行植皮创面愈合外,其余皮瓣全部成活。创面一期愈合47例,二期愈合3例;术后皮瓣整形17例。随访6个月～2年,足部功能及外形恢复较满意。结论根据足部皮肤缺损的部位、面积大小及周围组织条件．选择不同娄型外科皮瓣修兔创面．可获得满意效果．     

足内侧逆行岛状皮瓣修复前足皮肤缺损

目的　研究修复前足皮肤缺损的新方法。方法　在解剖学研究的基础上 ,利用足底内侧动脉终支与第 1跖骨底动脉、足底深动脉及足底深弓的吻合 ,设计逆行足底内侧血管及足内侧皮穿支蒂岛状皮瓣修复前足皮肤缺损创面。结果　临床应用 6例 ,皮瓣面积 4cm× 3cm～ 11cm× 9cm ,血管蒂长 6～ 11cm ,皮瓣全部成活 ,随访 6～ 2 4个月 ,外形与功能改善满意。结论　本皮瓣是修复前足皮肤缺损的最佳选择之一。     

带腓动脉的腓浅神经营养血管皮瓣修复前足软组织缺损

目的 总结带腓动脉的腓浅神经营养血管皮瓣逆行转位修复前足皮肤软组织缺损的临床效果. 方法 2007年1月至2011年12月,应用带腓动脉的腓浅神经营养血管皮瓣逆行转移对12例前足皮肤软组织缺损进行修复,皮瓣切取面积为6cm×4cm～18cm×12cm. 结果 仅1例术后36 h出现皮瓣瘀血肿胀,皮瓣远端出现表皮下积液,与蒂部缝合过紧有关,及时拆除蒂部部分缝线,皮瓣转红润,顺利成活,其余皮瓣均顺利成活.8例得到3个月～3年的随访,皮瓣外形满意,耐磨.吻合神经的7例中有5例得到随访,皮瓣两点辨别觉在10 ～ 14 mm. 结论 带腓动脉的腓浅神经营养血管皮瓣血供丰富,切取简便,随意转移性强,外观好,是修复前足较大面积皮肤软组织缺损理想的方法之一.     

足底内侧皮瓣在足跟部恶性黑色素瘤的应用

目的探讨足跟部恶性黑色素瘤的手术切除和修复重建的方法。方法5例老年足跟部恶性黑色素瘤患者,手术行局部扩大切除,切缘距病损2cm,深度达跟骨骨膜,足跟部软组织缺损Ф5～9cm,根据缺损大小,用带足底内侧血管神经束的皮瓣移位修复,皮瓣面积8cm×6cm-10cm×8cm。结果5例皮瓣全部成活。随访2年6个月～5年,患者均健在,肿瘤未见局部复发,皮瓣感觉功能良好,患足功能与对侧相比无明显差异。结论足跟部恶性黑色素瘤应行局部扩大切除术,切除范围应距肿瘤边缘不小于2cm为宜,在切缘阴性的基础上进行修复重建,应用足底内侧皮瓣移位修复,临床疗效满意。     

Long-term sensation in the medial plantar flap: A two-centre study

BackgroundReconstruction in the foot and ankle region is challenging. This study aimed to quantify objective sensation return when a sensate medial plantar flap is used for like-for-like reconstruction of foot and ankle defects.MethodsTwo-point discrimination (2PD) was assessed in flap and normal tissue at a minimum of 1 year post-operatively. A paired T-test assessed for significance.Results8 patients were included. Mean 2PD in normal tissue and flap was 29 mm (SD: 11.9) and 33 mm (SD: 9.97) respectively with no statistically significant difference between the two (two-tailed p-value: 0.1898). Mean age was 53.2 years (range: 15–84). There was no statistically significant correlation between age and 2PD in flap tissue (r = 0.6, p = 0.15).ConclusionsThis is the largest case series of its kind. Our results suggest that sensation in medial plantar flaps can return to near normal and demonstrate the important role the medial plantar flap plays in soft tissue reconstruction in this region.     

Coverage of heel defects by musculocutaneous and fasciocutaneous flap based on medial plantar neurovascular bundle

Summary Five musculocutaneous flaps based on the medial plantar neurovascular bundle were used for complete loss of skin and subcutaneous tissue of the heel and three fasciocutaneous flaps for its partial loss. All flaps survived completely. These flaps had good sensitivity and resisted weight-bearing conditions. The patients have been free from recurrent ulceration in the heel and have had no difficulties with walking.[/ab]     

三种游离穿支皮瓣修复足背及前足组织缺损

目的探讨游离膝降动脉穿支皮瓣、隐动脉穿支皮瓣及股前外穿支皮瓣修复足背及前足软组织、复合组织缺损的疗效。方法纳入2010年8月至2014年10月35例足背及前足组织缺损患者,创面面积为9 cm×4.5 cm~26 cm×13 cm。采用游离膝降动脉穿支皮瓣修复12例(A组),游离隐动脉穿支皮瓣修复8例(B组),游离股前外穿支皮瓣修复15例(C组)。若为开放性损伤,则在皮瓣移植术前应用负压封闭引流装置覆盖5~7 d。结果术后34例皮瓣全部成活,仅1例(女童,7岁)股前外穿支皮瓣远端1/3坏死,2周后经削痂植皮后创面愈合。术后随访3~38个月,平均12.3个月。皮瓣修复后外形大多令人满意,术后3个月A组有3例、B组有2例进行二次修薄手术。A组有1例出现小腿持续肿胀,1例出现供区切口愈合不良;B组有5例出现供区肢体持续肿胀,3例出现供区切口愈合不良,4例供区远端出现皮疹。结论游离膝降动脉穿支皮瓣及游离隐动脉穿支皮瓣修复后大多需行二次修薄手术。游离股前外穿支皮瓣质地好,切取面积大,可避免二次修薄手术,受区影响较小,但仅可用于单纯足背或前足软组织覆盖。游离膝降动脉穿支皮瓣可制备皮-骨或皮-肌(肌腱)复合瓣用于修复足部复合组织缺损。     

足底内侧皮瓣在足跟部皮肤恶性肿瘤手术缺损修复中的应用

目的探讨足跟部皮肤恶性肿瘤切除后皮肤软组织缺损利用足底内侧皮瓣转移进行修复的方法并评价其疗效。方法对11例足跟周围皮肤恶性肿瘤患者病变局部扩大切除后,在肿瘤边界完整切除的基础上,皮肤软组织缺损采用足底内侧皮瓣转移进行修复。结果 11例均获随访,时间10个月~6年。转移皮瓣均成活,外形满意,感觉恢复,足及足趾活动良好,未见肿瘤复发。结论足底内侧皮瓣修复足跟部皮肤恶性肿瘤切除软组织中小面积缺损疗效较好。     

Release of hand burn contracture: Comparing the ALT perforator flap with the gracilis free flap with split skin graft

Background

The use of microsurgery in the management of burn sequelae is not a new idea. According to the properties of various types of free flaps different goals can be achieved or various additional procedures have to be combined. We report the comparison of two different free flaps on a single patient for reconstruction of both upper extremities for burn sequelae.

Case report

A 1-year-old child sustained severe burns on both hands, arms and thorax and was initially only treated conservatively. This resulted in severe contractures. At the age of 4-years a free gracilis flap was selected for reconstruction of his left hand and a free anterolateral thigh flap for the right hand.

Results

We noticed a better functional and esthetic result for the gracilis flap associated with a shorter operative time and a minor donor site morbidity. The intraoperative technique and time, postoperative complications, functional and esthetic results and donor site morbidities were studied in the two types of flaps chosen. A review of literature was also performed.

Conclusion

Our experience reported a better success of the gracilis muscle flap covered with a split skin graft compared to the anterolateral thigh flap in the reconstruction of hand function after severe burn sequelae.     

Reverse flow flap use in upper extremity burn contractures

Upper extremity contractures still happen and constitute one of the most trying challenges in burn patients. This series comprised of 4 radial forearm flaps, 14 dorsoulnar artery flaps, and 4 medial arm flaps, all of which were used in a reverse pattern for upper extremity postburn contractures. The reverse flow radial forearm flap (RRFF) was chosen for reconstruction of extensive palmar contractures after burn. The reverse flow dorsoulnar flap (RDUF) was used particularly for reconstruction of the hypothenar aspect of the hand which requires moderate size tissue transfer. The reverse medial arm flap (RMAF) was used for elbow contractures after burn. In the first RMAF, venous congestion occured and was finaly resolved with minimal flap loss, which was managed with STSG later. In the following 3 cases the flap was supercharged with anastomosis of the brachial vein into the antebrachial vein. Both RRFF and RDUF may provide a smooth and efficient solution. However, RMAF has a significant venous problem, which may result in flap loss, therefore, this flap should not be considered as a first option in the elbow area.     

A pilot comparison of forefoot plantar pressures in newly diagnosed rheumatoid arthritis patients and non-rheumatic subjects

BackgroundIn rheumatoid arthritis (RA) forefoot pathology is often related to increased peak plantar pressures under the metatarsal heads.ObjectivesThis study sought to assess peak plantar pressures in newly diagnosed RA patients compared to non-rheumatic subjects.MethodPlantar pressure in a group of 10 pain free RA patients diagnosed within two years before the starting date of the study and 10 healthy volunteers matched for gender, age and weight were assessed. Each group consisted of seven females and three males aged between 30 and 55 years.ResultsThe results showed no significant difference (ρ = 0.420) at the hallux, however there was a statistical difference in all the other regions (ρ = 0.000 and p = 0.011 for 1st MPJ and 2nd–4th MPJ respectively and p = 0.007 for 5th MPJ). The RA group had higher pressure underneath the 1st and 2nd–4th MPJ regions and lower pressures underneath the 5th MPJ.ConclusionAlthough it is for a small group of patients, the results from this pilot study show that even at an early stage of RA, forefoot pressures are shifted toward the medial MPJs.     

足底内侧游离皮瓣、肌皮瓣移植修复足跟缺损

我们采用吻合血管、神经的足底内侧游离皮瓣、肌皮瓣移植修复足跟软组织缺损８例，皮瓣全部成活。４～６周后负重行走，经６～２４个月随访，移植皮瓣无１例出现溃疡，感觉恢复良好，两点分辨觉达２．０～３．０ｃｍ。我们强调了神经吻合的重要性，认为皮瓣的感觉恢复是防止溃疡发生、取得远期良好效果的首要条件。     

比目鱼肌内侧半肌瓣逆行移位术的临床应用

目的　为临床上治疗胫骨中下段及踝部慢性骨髓炎合并软组织缺损提供一种一期修复的方法。方法　通过比目鱼肌内侧半血供主要由胫后动脉节段分支供应的解剖学特点 ,设计切取比目鱼肌内侧半肌瓣逆行移位术 ,其最低旋转点为内踝突出点上 10 .0 cm(9.70 cm± 2 .43cm)处。结果　经临床应用 2 4例 ,平均随访 2年 ,均取得满意疗效。结论　比目鱼肌内侧半肌瓣逆行移位术是治疗胫骨中下段及踝部慢性骨髓炎合并软组织缺损的一种简便有效的新术式     

“Like For Like” Reconstruction of Heel Pad with Medial Plantar Artery Flap—Functional and Aesthetic Outcomes in A Series of 19 Cases

Heel pad loss can cause serious problems in weight-bearing and locomotion. The medial plantar artery (MPA) flap is a suitable “like for like” replacement. Nineteen patients whose heels were reconstructed with MPA flap between July 2015 and February 2020 were studied. All patients were assessed based on flap survival, functionality, and patient satisfaction. Loss of heel pad was due to diabetic ulcer (11), trauma (6), tumor (1), and unstable scar (1). The largest flap measured 9 × 7 cm. Sixteen flaps were done as fasciocutaneous flaps and three in combination with abductor hallucis muscle (AbdH). All the flaps survived. The average functional scores at 6, 12, 18, and 24 months were 86.86, 89.62, 89.38 and 97.33 based on AOSAS-AH score. Average patients'' satisfaction was 8.7/10. To conclude, the MPA system is a versatile vascular axis providing “like for like” tissue for heel pad reconstruction which is reliable and durable.     

胫后动脉穿支联合隐神经营养血管筋膜蒂皮瓣修复足底内侧创面

目的探讨用胫后动脉穿支联合隐神经营养血管筋膜蒂皮瓣二期修复足底内侧创面的手术技术和临床疗效。方法2016年1月至2018年12月,采用胫后动脉穿支联合隐神经营养血管筋膜蒂皮瓣修复足部内侧软组织缺损创面共13例,其中男9例,女4例,年龄23~69岁,平均36.9岁。损伤缺损位置均位于足底内侧跖跗关节附近,软组织缺损面积为4.5 cm×5.0 cm^8.0 cm×14.0 cm,皮瓣供区直接拉拢缝合或取同侧大腿全厚皮片游离植皮部分修复。所有患者术后采用门诊及电话定期随访。定期随访,观察患肢功能、皮瓣供区及受区愈合情况。结果13例皮瓣顺利成活;1例远端出现小面积坏死,部分拆线减压,经换药后愈合;1例出现皮瓣瘀紫及张力性水泡,手术探查、去除局部血肿、蒂部拆线减压后皮瓣成活;1例患者术后8个月予以皮瓣削薄整形。本组患者术后均获6~12个月随访,皮瓣颜色、温度、毛细血管反应正常,皮瓣质地柔软,外形不臃肿,患足行走无明显受限,功能恢复基本满意。结论胫后动脉穿支皮瓣携带隐神经和大隐静脉可使皮瓣成活更可靠,血运更理想,将皮瓣所携带的隐神经与受区皮神经缝接,可以重建皮瓣的保护性感觉,是临床修复足底内侧创面的一种有效方法。     

逆行外踝上筋膜皮瓣修复前足缺损的解剖学基础

目的 为改良逆行外踝上筋膜皮瓣的临床应用提供解剖学依据。方法 对30侧新鲜下肢标本进行显微解剖，观测腓动脉终末穿支降支及其交通支的起始、长度、外径、走行、分支及毗邻关系等。结果 外踝上动脉降支在外踝下与外踝前动脉、跗外侧动脉、跟外侧动脉、足底外侧动脉之间均有广泛的吻合支存在，且吻合血管恒定，外径在1mm左右，可以此设计逆行外踝上筋膜皮瓣的旋转轴点以扩大皮瓣的应用范围。结论 改良逆行外踝上筋膜皮瓣血运可靠，质地佳，血管蒂长，可逆行修复前足的软组织缺损。