Split Overlapping Anterolateral Thigh Perforator Flap for Plantar Foot Reconstruction-Case Report

以前外側大腿皮瓣來重建足跟－病例報告

陳建安(Jian-An Chen) ； 馮冠明(Guan-Ming Feng) ； 姚勝發(Shen-Fa Yao) ； 劉奕添(Yi-Tien Liu) ； 陳宏基(Hung-Chi Chen)

《臺灣整形外科醫學會雜誌》 20卷2期 (2011/06) Pp. 136-141

https://doi.org/10.7096/TJTSPS.201106.0136

摘要

背景：
足底及足跟之重建一直是外科醫師的挑戰，因足部本身獨特的皮膚構造提供負荷身體重量及對抗行走時產生的剪力，是身體其他地方的皮膚所無法取代，如何適當地重建足跟及足底也成爲整形外科醫師的一項目標。
目的與目標：
以單一手術來重建足底及足跟，同時維持足部正常之功能。
材料與方法：
一個十七歲女性因車禍導致右足皮膚及軟組織之嚴重缺損及骨暴露，我們以單一手術採前外側大腿皮瓣分割重組的方法來重建足底及足跟，術後追蹤病人傷口及功能的復原狀態。
結果：
病人手術及術後復原順利，在兩年的追蹤下，並無足部潰瘍之發生，且有適當的感覺及功能。
結論：
以我們提供的方法，可以藉由單一手術完成足部的重建。

並列摘要

Background:
Reconstruction of the heel and sole remains a difficult and challenging problem. The thick glabrous skin together with the fibrous septa of the subcutaneous layer, provide unique properties for withstanding the shearing forces associated with gait.
Aim and Objectives:
The ideal reconstruction, not only should achieve durable coverage, and adequate contour, but most importantly must be able to resist such shearing forces. We propose an innovative method for a one-stage reconstruction of the weight bearing heel and sole using a partially overlapping split anterolateral thigh perforator flap.
Materials and Methods:
A 17-year-old female patient sustained a right heel and sole degloving during a road traffic accident. The degloved heel and sole became necrotic at three days post-injury. This left a 17 x 7cm defect with exposed calcaneal bone after debridement. A split anterolateral thigh perforator flap was designed for the three-dimensional reconstruction
of the heel and sole.
Results:
The operation was without complication and the postoperative course was uneventful. The patient was allowed to partially weight bear at one month and full weight bear at two months postoperatively. No ulcerations of the flap were observed during 2 years follow-up. The patient is now able to walk unaided and without the need for specially designed orthotics.
Conclusion:
The split overlapping anterloateral thigh perforator flap provide one stage procedure for heel and sole reconstruction without the need for debulking. This achieves satisfactory long-term functional results, optimizing restoration of foot function, with minimal donor-site problems.

並列關鍵字

anterolateral thigh flap ； heel reconstruction