携带感觉神经足底内侧动脉皮瓣修复足跟软组织缺损的临床应用
Clinical application of medial plantar artery flap carrying sensory nerve in repairing soft tissue defect of heel
目的 探讨携带感觉神经的足底内侧动脉皮瓣修复足跟区软组织缺损的临床应用效果。 方法 自2016年6月至2017年11月，笔者单位收治12例足跟皮肤软组织缺损患者,其中2例合并跟骨结节缺损(缺损长度小于1 cm)。采用携带感觉神经的足底内侧动脉皮瓣修复创面，创面面积（扩创后面积）为3 cm×4 cm~10 cm× 6 cm，切取皮瓣面积为3.5 cm×4.5 cm~11 cm×7 cm。通过观察皮瓣外观、血运、弹性及两点辨别觉评价临床效果。 结果 12例皮瓣完全成活。10例患者获随访6~14个月，皮瓣外观满意，质地柔软,无臃肿，弹性佳，两点辨别觉5~ 9 mm。8例无骨缺损患者穿鞋、行走不受限；2例合并骨缺损患者需穿软底带跟鞋且持续行走半小时感觉局部刺痛。 结论 携带感觉神经的足底内侧动脉皮瓣能较好的重建足跟外观、感觉及功能，是修复足跟软组织缺损的有效方式。
Objective To investigate the clinical efficacy of medial plantar artery flap carrying sensory nerve in repairing soft tissue defects in heel area. Methods From June 2016 to November 2017, 12 patients with calcaneal nodule defect (less than 1 cm in length) were treated in our hospital. The medial plantar artery flap carrying sensory nerve was used to repair the wound. The wound area ranged from 3 cm × 4 cm to 10 cm × 6 cm. The flap size ranged from 3.5 cm × 4.5 cm to 11 cm × 7 cm. The clinical efficacy was evaluated by observing the appearance, blood flow, elasticity and two-point discrimination of the flap. Results All flaps survived completely. 10 cases were followed up for 6~14 months. The flaps were satisfactory in appearance without bulkiness, soft in texture, good in elasticity. The two-point discrimination was 5 mm to 9 mm. 8 patients with no bone defect wore shoes, 2 patients with bone defect and without walking limitation needed to wear heeled shoes with soft soles and walk half an hour to feel local tingling pain. Conclusions The medial plantar artery flap with the sensory nerve can better reconstruct the appearance, sensation and function of the heel. It is an effective way to repair the soft tissue defect of the heel.
/ Surgical flaps / Medial plantar artery / Soft tissue defect / Heel
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