- 期刊
Outcome Evaluation of Skin-Grafted Free Muscle Flap versus Reverse Sural Fasciocutaneous Flap in Soft Tissue Reconstruction of Weight-Bearing Heel
皮膚移植之自由肌肉皮瓣和反向腓腸皮膚筋膜皮瓣在腳跟負重部位軟組織缺損重建上的結果比較
摘要
過去十年內共有十八位腳跟負重部位軟組織缺損的病人在本院整形外科接受皮瓣重建手術。其中11位是接受皮膚移植之自由肌肉皮瓣，8位是接受反向腓腸皮膚筋膜皮瓣。回顧及統計的結果，造成缺損的原因佔大多數是骨髓炎。平均而言，接受皮膚移植之肌肉皮瓣的患者年齡較輕，傷口面積較大，手術時間較長，住院時間較短。術後評估，皮瓣成功率及肢體存活率，兩者並無明顯不同。長期結果分析，接受皮膚移植之肌肉皮瓣的患者獲得較佳的生活功能及回復工作的可能，但產生反覆潰瘍的機會則較高。總結來說，皮膚移植之自由肌肉皮瓣是腳跟負重部位大量軟組織缺損重建上的優先選擇，而在年紀較大，不適合長時間手術的病人，反向腓腸皮膚筋膜皮瓣也可以到相當好的結果。
關鍵字
無資料並列摘要
There were eighteen patients received soft tissue reconstruction of weight-bearing heel at our institution in past 10 years. Eleven patients received skin-grafted free muscle flaps and seven received reverse sural fasciocutaneous flaps. The etiology of the wounds were osteomyelitis (55.6%), necrotizing fasciitis (11.1%), trauma (11.1%) and tumor resection (11.1%). The patients who received free muscle flap surgery were younger (average 45.2 y/o), had much larger wound size (12.4x 6.6cm^2) longer operative time, and less hospital days. The complication rate was comparable between these two modalities. They all achieved a considerable successful rate and limb salvage rate. The muscle flap group presented as higher percentage in resuming walking and working. It also had better functional score but higher chance of chronic ulcer. In consideration of weight-bearing heel reconstruction, the skin-grafted muscle flap seems to be the first choice. In elder patient or patient who is not suitable for long operative time, reverse sural fasciocutaneous flap is probably an alternative with acceptable successful rate but less functional result is expected.