Diverse Use of Medial Plantar Perforator Flap for Plantar Weight-Bearing Area Reconstruction at Mackay Memorial Hospital

內側足弓皮瓣重建足底傷害的多樣性：馬偕紀念醫院治療經驗

李安莉(An-Li Lee) ； 張世幸(Shih-Hsin Chang)

《臺灣整形外科醫學會雜誌》 25卷2期 (2016/06) Pp. 101-109

摘要

背景：腳掌特殊的緊緻，厚，無毛皮膚及較厚的皮下脂肪層能夠承受足底摩擦和負重。因此，重建足底全層缺損是有挑戰性的。以往的研究提出了數種重建方法。最令人關注的問題是術後皮瓣的耐用性。目的及目標：內側足弓皮瓣能提供與足底解剖構造一樣的皮膚與負重軟組織。供皮瓣區的併發症是微小的。我們報告使用內側足弓皮瓣重建足底缺損並且預後良好。材料及方法：在西元2005年11月至2015年8月之間，收集了12位足底損傷病人（2個前足底和10個腳後跟）使用內側足弓皮瓣重建（8個帶蒂皮瓣，3個自由皮瓣和1個交足皮瓣）並追蹤其預後。結果：平均缺損面積約6.75×5.75平方公分，術後追蹤時間平均30.9月。所有皮瓣皆存活。術後追蹤有2個案例部分邊緣壞死，2個皮瓣縫合部分分離。2個供皮瓣區分層植皮部分角質增生，1個供皮瓣區之分層植皮部分潰瘍。患側部分負重復健平均始於術後第4周，約再一個月使用全負重行走並且無須輔具使用。結論：選擇內側足弓皮瓣重建足底負重處的缺損是個不錯又有效的手術方式。這個方式可以提供良好的術後皮瓣耐受性，而且沒有嚴重併發症的產生。

並列摘要

Background: The plantar anatomy is unique. The tight, thick, and glabrous epidermis and dermis with a thick subcutaneous layer provide protection to the plantar foot against friction and weight bearing. Reconstruction of a full-thickness defect of the plantar foot is challenging. Several reconstruction methods have been proposed in previous studies. The most pervasive problem is post-operative flap durability. Aim and Objectives: A medial plantar flap provides the same plantar skin with endurable tissue that is suitable for weight bearing. The donor site morbidity is minimal. We report the diverse use of a medial plantar flap for reconstructing weight-bearing plantar defects with good outcomes. Materials and Methods: Between November 2005 and August 2015, we studied 12 cases of plantar foot (two forefeet and 10 heels) reconstruction with medial plantar flaps (eight pedicle flaps, three free flaps, and one cross-foot flap) and their outcomes. Results: The mean defect size was 6.75 cm × 5.75 cm (range, 4 × 4 cm to 9 × 7 cm). The average follow-up duration was 30.9 months (range, 2- 101 months). All flaps survived. Two cases showed flap margin partial necrosis and two had partial dehiscence. Two cases had instep grafted skin hyperkeratosis and one had erosion. The average time of partial weight bearing started at the 7.6 th postoperative week (range, 4th week to 3rd month), and full weight bearing without aids or custom-made shoes began 1 month later. Conclusion: We report the diverse use of a medial plantar flap for reconstructing full-thickness weight-bearing plantar defects with good durability and outcomes without major complications.

並列關鍵字

medial plantar flap ； plantar reconstruction