足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部软组织缺损

目的探讨足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部皮肤软组织缺损的临床效果。方法回顾性分析2015年10月至2020年12月榆林市第二医院烧伤整形手足外科收治的足跟部皮肤软组织缺损患者的临床资料。患者经急诊清创或扩创后,应用足底内侧岛状皮瓣修复足跟部创面,腹股沟游离皮瓣修复足底内侧供区创面,腹股沟供区直接缝合。术后观察皮瓣血运及存活、皮瓣供区愈合情况,并对足跟外形与功能恢复情况进行随访。结果共纳入8例患者,男7例,女1例,年龄20~71岁,平均32.2岁。其中5例为足跟外伤,1例足跟鳞状细胞癌,1例足跟冻伤,1例足跟溃疡。足跟部创面面积4 cm×3 cm~7 cm×6 cm。手术过程顺利,足跟岛状皮瓣及腹股沟皮瓣切取范围较足跟创面扩大0.5~1.0 cm。8例患者术后皮瓣血运良好,创面均一期愈合。术后随访3~12个月,所有患者足跟弹性佳,外形无臃肿,耐磨、耐压,感觉及行走功能满意;足底内侧供区无凹陷,无瘢痕增生及挛缩,无局部皮肤溃疡;腹股沟供区仅见线性瘢痕。结论足底内侧岛状皮瓣联合腹股沟游离皮瓣修复足跟部缺损,足部外观及功能恢复良好,效果满意。

Combined medial plantar flap and groin flap for reconstruction of heel soft tissue defects

Objective To investigate the clinical effect of medial plantar flap combined with free groin flap in the reconstruction of heel defect.Methods The patients with heel skin and soft tissue defects admitted to the Department of Burns&Plastic and Hand&Foot Surgery of Yulin No.2 Hospital from October 2015 to December 2020 were retrospectively analyzed.After emergency debridement,a plantar medial island flap was used to repair the foot heel defect,a free groin flap was used to repair the medial plantar donor site,and the groin donor site was closed primarily.Postoperatively routine anti-infection,spasmolysis,anticoagulation,expanding treatment were performed after the procedure.The blood supply,survival of the flap,and the healing of the donor area of the flap were observed.The shape and function of the heel were observed in follow-up.Results Eight patients were enrolled,including 7 males and 1 female,aged from 20 to 71 years,with an average of 32.2 years.There were 5 cases of heel trauma,1 case of heel squamous cell carcinoma,1 case of heel frostbite,and 1 case of heel ulcer.The wound area of the heel was 4 cm×3 cm-7 cm×6 cm.The surgical procedure was smooth,and the incision range of the heel island flap and groin flap was 0.5-1.0 cm larger than that of the heel wound.All 8 patients had primary healing after the operation.Follow-up for 3-12 months showed that all patients were satisfied with heel shape,sensory function and walking function.There was no depression,scar hyperplasia,and contracture in the medial plantar donor area,and no local skin ulcer.There is only a linear scar in the groin donor area.Conclusions Medial plantar island flap combined with a free groin flap can repair the defect of the heel,and the affected foot has good healing,certain sensory function,and satisfactory curative effect.