Reverse-Flow Lateral Tarsal Island Flap for Covering the Great Toe Donor Site of Wraparound Flap
Reverse-Flow Lateral Tarsal Island Flap for Covering the Great Toe Donor Site of Wraparound Flap
复制标题
用于覆盖包裹皮瓣大脚趾供体部位的逆流侧跗骨岛状皮瓣
DOI：
10.1097/sap.0000000000000612
复制
发表时间：
2016-10-01
影响因子：
1.5
通讯作者：
Chai, Yimin
中科院分区：
文献类型：
--
作者：
Jia, Yachao;Xu, Jia;Chai, Yimin
研究背景：对于拇趾供区的覆盖，目前仍是一个难题。本文报告一个以带神经蒂之逆行跗外侧岛状皮瓣，覆盖环绕皮瓣供趾区之结果。患者与方法2005年至2010年，我们应用逆行跗外侧岛状皮瓣修复11例拇趾供区皮瓣。该皮瓣以足背动脉为蒂，设计于足外侧跗区，将足背外侧皮神经与足外侧逆行岛状皮瓣结合，并与第一趾足底神经吻合。逆行睑板外侧岛状皮瓣供区以腹股沟全厚皮片覆盖。结果除2例皮瓣出现轻度静脉功能不全经保守治疗外，其余皮瓣均一期愈合。所有覆盖逆行跗外侧岛状皮瓣供区的皮片均顺利愈合。平均随访时间为24个月（范围：18-48个月）。术后6个月时，平均拇趾跖趾间量表评分为92分（范围：85-97分）。逆行跗外侧岛状皮瓣的静态2点辨别力范围为6 ~ 14 mm，平均10 mm。随访期间，无患者站立或行走受限。结论足背动脉远端蒂逆行跗外侧岛状皮瓣蒂长恒定。这种带神经蒂皮瓣是一种可靠的选择，以覆盖拇趾供区的包裹皮瓣，具有满意的功能和美容效果和可接受的供区并发症。
BackgroundCoverage of the great toe donor site of wraparound flap remains a challenge. This report presents the results of using an innervated pedicled reverse-flow lateral tarsal island flap for covering the great toe donor site of wraparound flap. Patients and MethodsBetween 2005 and 2010, 11 reverse-flow lateral tarsal island flaps were used to cover the great toe donor site of wraparound flap in 11 patients. This pedicled flap designed on the lateral tarsal area of foot was based distally on the dorsalis pedis artery; the lateral dorsal pedal cutaneous nerve was incorporated into the reverse-flow lateral tarsal island flap and coapted with the first plantar digital nerve. The donor sites of reverse-flow lateral tarsal island flap were covered with inguinal full-thickness skin grafts. ResultsAll flaps achieved primary healing except for two that suffered from mild venous insufficiency which was managed by conservative intervention. All skin grafts covering the donor site of reverse-flow lateral tarsal island flap healed uneventfully. The mean follow-up was 24 months (range, 18–48 months). The mean hallux metatarsophalangeal-interphalangeal scale score was 92 points (range, 85–97 points) at 6 months postoperatively. The static 2-point discrimination of the reverse-flow lateral tarsal island flap ranged from 6 to 14 mm (mean 10 mm). None of the patients were restricted in standing or walking during follow-up. ConclusionsThe reverse-flow lateral tarsal island flap based distally on the dorsalis pedis artery has a constant pedicle that is sufficiently long. This innervated pedicle flap is a reliable option to cover the great toe donor site of wraparound flap with satisfactory functional and cosmetic results and acceptable donor site morbidity.