Resurfacing Tophaceous Gout in the Foot with a Medial Sural Artery Perforator Flap

腓腸內側動脈穿通支皮瓣覆蓋痛風石痛風導致之足背潰瘍－一個病例報告

林進達(Chin-Ta Lin) ； 陳天牧(Tim-Mo Chen) ； 陳錫根(Shyi-Gen Chen)

《臺灣整形外科醫學會雜誌》 21卷2期 (2012/06) Pp. 143-148

https://doi.org/10.7096/TJTSPS.201206.0143

摘要

背景：當足背之痛風石性痛風逐漸擴大時，常會造成足部功能受損、感染合併膿性分泌物及皮膚壞死，最後導致大範圍皮膚及軟組織缺損，合併關節、骨頭、肌腱、神經及血管暴露。應此，足背之大範圍皮膚及軟組織缺損在重建上仍是一大挑戰。目的及目標：我們報告一個以腓腸內側動脈穿通支皮瓣來重建因痛風石性痛風導致足背之大範圍皮膚及軟組織缺損之病例報告，並且探討文獻上之重建方式。材料及方法：一位39歲男性病患因為痛風石性痛風導致足背皮膚壞死及潰瘍合併關節、骨頭及肌腱暴露。此病患在診所接受清創後轉至本院，傷口大小約為5.5x3.5平方公分，伴隨有膿樣分泌物。病患入院後接受進一步手術清創治療，隨後我們設計一個腓腸內側動脈穿通支皮瓣來覆蓋病患足背缺損。結果：病患術後恢復良好，沒有莖蒂之壓迫或血栓，皮瓣沒有血腫、感染或癒合不良之情況，術後病患接受良好之飲食衛教、運動及規則服藥來控制尿酸並預防復發。手術後三個月，病患的右下肢皮瓣除完全恢復外，並且有良好的足部外觀。結論：慢性痛風石性痛風可造成足背的感染及皮膚壞死，若不盡早治療甚至導致足部嚴重變形及敗血症。一般而言，手術介入清創治療通常無法避免。我們報告一個以腓腸內側動脈穿通支皮瓣來重建因痛風石性痛風導致足背皮膚及軟組織缺損之病例報告，重建後不僅傷口快速恢復，外觀及功能也恢復良好。

並列摘要

Background: Large or extensive gouty tophi on the feet can cause functional impairment, drainage sinus, and infected necrosis, finally resulting in complex soft-tissue defects with tendon, joint, bone, nerve, and vessel exposure. Reconstruction of the complex soft tissue defect in the foot is still challenging.Aim and Objectives:We reconstructed a large ulcerative skin and soft tissue defect of dorsal foot secondary to chronic tophaceous gout by a free medial sural perforator flap after series of debridement of the infectious wound. A literature review of reconstructions of ulcerative skin and soft tissue defects of dorsal foot is discussed.Materials and Methods: A 39-year-old man had persistent chronic tophaceous gout, with skin necrosis between the 4(superscript th) and 5(superscript th) tarsometatarsal joints of the dorsum of the right foot. The patient was referred to our hospital after an initial debridement at a local clinic and the wound defect on the right foot was approximately 5.5 × 3.5 cm in size. After debridement, we designed a medial sural artery perforator flap (size, 8 × 4.5 cm), which was raised from his right calf to restore the soft tissue defect.Results:Postoperative course was uneventful without observed postoperative complications, such as compromised flap pedicle, vascular thrombosis, hematoma, and wound infection or dehiscence. The patient was instructed to follow a controlled diet, exercise regularly, and take regular medications to control gout and prevent the recurrence of the tophaceous masses. The thin flap was completely viable after surgery and showed good survival and aesthetic outcome at the 3-month follow-up.Conclusion:Chronic tophaceous gout can cause severe extensive infection and skin necrosis, and can even result in deformity or sepsis if left untreated. Surgical debridement becomes inevitable when the infected necrotized wound is located over a tophaceous mass. In this case, after the initial debridement, we performed a medial sural perforat or flap for his large ulcerative skin and soft-tissue defects on the dorsum of the foot, which were secondary to chronic tophaceous gout, and achieved good functional and cosmetic results.

並列關鍵字

tophaceous gout ； free flap ； medial sural flap