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Cross-Foot Reversed Medial Plantar Artery Flap for Management of Persistent Wound after Complex Heel Reconstruction- A Case Report

使用交足式逆行內側足底動脈皮瓣處置複雜腳跟創傷重建後之持續性傷口─病例報告

摘要


背景:對於整形外科醫師而言,重建進行腳跟處軟組織缺損的重建是具有挑戰性的。而使用交足式逆行內側足底動脈皮瓣取代自由皮瓣的重建在文獻報告上更是罕見。目的及目標:我們提出一個先前已使用自由皮瓣手術重建的右腳跟上有持續性傷口的案例,再利用交足式逆行內側足底動脈皮瓣重建術後的結果及追蹤。材料及方法:一名28歲女性患者,10年前因車禍造成右跟骨複雜性骨折併皮膚缺損,接受多次手術治療,包括使用對側脛后動脈做為受體血管的右大腿前外側自由皮瓣重建手術。長時間負重下,導致在皮瓣重建的右腳跟處有持續性傷口發生。因為病患雙足的血管損傷缺陷,故可利用交足式逆行內側足底動脈皮瓣來進行重建。結果:手術過程及術後恢復良好,病患在首次手術後8周開始進行腳跟負重訓練。持續追蹤一年,病患覺得滿意且行走負重良好,沒有皮瓣或皮瓣供應區的併發症出現。截至目前也沒有再次因負重而導致局部皮膚缺損出現。結論:我們成功使用交足式逆行內側足底動脈皮瓣為雙腳血管有損傷缺陷、且於先前皮瓣重建處有持續性傷口的案例進行重建。若有此類較複雜,無法使用蒂根內側足底動脈皮瓣或遠端自由皮瓣進行重建的腳跟負重處有皮膚缺損的類似案例,可以考慮使用交足式逆行內側足底動脈皮瓣做為另一種的手術治療選項。

關鍵字

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並列摘要


Background: Reconstruction of soft tissue defects around the heel remains a challenging problem for plastic and reconstructive surgeons. There have been rare reports on the usage of cross-foot procedures instead of free flap transfers. Aim and Objectives: We report a case in which a cross-foot reversed medial plantar artery flap (instep flap) was used to manage a persistent ulcer involving a fasciocutaneous flap previously transferred to the right heel. Materials and Methods: A 28-year-old female patient had a history of a complex calcaneus facture with skin defect of the right foot caused by a traffic accident 10 years prior to the initial presentation. Several operative treatments were performed, including a right free anterolateral thigh (ALT) flap transferred to the right heel; the recipient vessel in this case was the contralateral posterior tibial artery. A persistent ulcer on the flap at the site of the right heel was noted after prolonged weight bearing. Given the vascular disruption of both feet, an instep flap reconstruction was indicated. Results: The surgery and postoperative period were unremarkable, and weight bearing was encouraged 8 weeks postoperatively. At her 1-year follow-up, the patient was ambulating well and experienced no flap or donor site morbidity. No further skin breakdown on the weight-bearing area during the follow-up period was observed. Conclusions: In the case of complicated vessel disruption and persistent wounds after complex heel reconstruction, we successfully used the instep flap for reconstruction. We suggest that the cross-foot reversed instep flap should be considered as an alternative treatment option for weight-bearing plantar foot reconstruction when pedicled instep flaps and distant free flaps are not available.

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