Repair of Posterior Heel Skin Defect with a Lateral Calcaneal V-Y Advancement Flap

使用跟骨外側V-Y移前皮瓣來重建腳後根皮膚缺損

陳建忠(Chien-Chung Chen) ； 陳明庭(Ming-Ting Chen) ； 黃介琦(Chieh-Chi Huang) ； 林廷龍(Ting-Lung Lin) ； 鄭勝峰(Seng-Feng Jeng) ； 江原正(Yuan-Cheng Chiang) ； 謝青華(Ching-Hua Hsieh)

《中華民國整形外科醫學會雜誌》 16卷3期 (2007/09) Pp. 189-196

https://doi.org/10.7096/JPSA.200709.0189

摘要

因為壓瘡、外傷或糖尿病足引起的腳後跟皮膚缺損常伴隨著阿基里斯肌腱及跟骨的曝露而使得一般傷口換藥或植皮手術難以成功。傳統跟骨外側皮瓣使用了相似的組織重建缺損，為腳後跟區域提供一個薄而強韌的皮膚包覆，使病患得到一個良好外觀和正常穿鞋行走的機會，同時保留了皮瓣腓腸神經所支配的神經感覺，可以減少壓瘡復發。但是供皮區需要皮膚移植覆蓋則是其主要的缺點。我們設計了根源於外側跟骨動脈的三角形皮瓣，並將此皮瓣以V-Y移前方式來覆蓋傷口，而所有的傷口都可以直接縫合。此種設計保有了原來的外側跟骨動脈皮瓣的優點，並避免了皮膚移植的需要。從一九九九年七月至二00五七月，共十一位病患（七位導因於壓瘡、兩位外傷及兩位糖尿病足）接受了此項手術來重建腳後跟的皮膚缺損。其中有二名女性及九名男性病患，平均年紀五十八歲。所重建最大的缺損為二點五公分乘以四公分。所有的皮瓣均成功存活，並沒有產生動脈供血不足或靜脈充血的問題。其中有一位病人有傷口感染，一位病人的皮瓣尖端有壞死現象。此兩位病人皆有糖尿病病史，經過一段時間換藥後，傷口漸漸癒合而不需要另一次的手術。為了減少供皮區傷口直接縫合後的張力，我們建議皮瓣設計時其尖端位置應放在足背第四、第五蹠骨間皮膚較鬆之處，而且術後應使用短腿石膏保持足於外翻的姿勢。簡而言之，跟骨外側V-Y移前皮瓣來重建腳後跟皮膚缺損是一個不錯的選擇，但因為皮瓣設計之考量及為了要能直接縫合傷口的關係，其只適用修補縱向的小面積皮膚缺損。

並列摘要

With exposure of the Achilles' tendon and calcaneal bone, soft tissue defect of the posterior heel resulted from pressure sore, trauma or diabetic wound is hard to be closed by wound healing with second intension or skin grafting. Conventional lateral calcaneal artery skin flap allows patient to wear normal shoes and walk by using the similar tissue adjacent to the defect for reconstruction, providing thin and durable skin coverage with an acceptable appearance, and preserving a senate flap based on the sural nerve which would prevent recurrence of the pressure sore. However, the necessity of skin graft at donor site is a major disadvantage of the flap. We designed a triangular skin flap based on the lateral calcaneal artery and mobilized the flap in a V-Y fashion to repair the defect. The entire wound could be closed directly. This lateral calcaneal V-Y advancement flap has the advantages of conventional lateral calcaneal flap and avoids the necessity of skin graft. From 1999 July to 2005 July, eleven patients (7 defects attributed to pressure sore, 2 defects due to trauma and 2 defects resulted from the diabetic wound) received reconstruction for a posterior heel defect with this flap. There were 2 female and 9 male patients, with average ages being 58 years old. The largest defect that repaired was 2.5 cm plus 4 cm in dimension. All flaps survived successfully without arterial insufficiency or venous congestion. One patient sustained postoperative wound infection and one patient had gangrene in tip of flap. Both of them had the diabetes mellitus history. The wounds of these patients healed gradually after daily wound care and no secondary operation was required. To relieve tension over the donor site in wound closure, we suggested placing the tip of the flap over the less tense region between the fourth and the fifth metatarsal heads of the dorsum of the foot in flap design, and use of a short leg splint to keep the eversion position of foot after surgery. Repair the posterior heel defect with a lateral calcaneal V-Y advancement flap is a good choice; however, because of intention to close the entire wound directly as well as consideration in the flap design, this flap could only repair longitudinal located small defect of the heel.

並列關鍵字

Lateral calcaneal flap ； V-Y advancement flap ； Island pedicle flap ； Posterior heel defect ； Calcaneal bone exposure