REPAIR OF PALM SOFT TISSUE DEFECT WITH MEDIAL TARSAL COMBINED WITH MEDIAL PLANTAR FLAP PEDICLED WITH FREE DORSALIS PEDIS ARTERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JINWenhu , CHANGShusen ,  WEIZairong , LIHai , ZHANGZiyang , SUNGuangfeng , WANGBo , TANGXiujun , NIEKaiyu , QIJianping

Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P.R.China;

Corresponding author：

WEIZairong, Email: zairongwei@163.com

Keywords：

Palm; Soft tissue defect; Foot; Free flap; Wound repair

DOI：

10.7507/1002-1892.20160283

Video：

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Objective To investigate the effectiveness of medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery in the repair of palm soft tissue defect. Methods Between September 2013 and December 2015, 9 cases of palm soft tissue defects were repaired with medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery. There were 7 males and 2 females with a mean age of 33 years (range, 21-52 years). The causes included traffic accident injury in 4 cases, crushing injury by heavy object in 3 cases, and electrical injury in 2 cases. The time between injury and admission was 3 hours to 2 days (mean, 9 hours). Five cases had pure soft tissue; combined injuries included tendon exposure in 2 cases, median nerve defect in 1 case, and exposure of tendon and nerve in 1 case. After debridement, the soft tissue defect area ranged from 6 cm×4 cm to 11 cm×6 cm. The flap size ranged from 7.0 cm×4.5 cm to 13.0 cm×7.0 cm. The vascular pedicle length was from 6 to 10 cm (mean, 7.5 cm). The donor sites were covered with ilioinguinal full thickness skin graft. Results Nine flaps survived, primary healing of wound was obtained. Partial necrosis occurred at the donor site in 1 case, and the other skin graft successfully survived. All patients were followed up 6-20 months (mean, 10 months). All flaps had soft texture and satisfactory appearance; the cutaneous sensory recovery time was 4-7 months after operation (mean, 5 months). At last follow-up, sensation recovered to grade S4 in 4 cases, to grade S_3⁺ in 3 cases, and to grade S3 in 2 cases; two-point discrimination was 7-10 mm (mean, 8.5 mm). According to Society of Hand Surgery standard for the evaluation of upper part of the function, the hand function was excellent in 5 cases, good in 3 cases, and fair in 1 case. The donor foot had normal function. Conclusion The medial tarsal combined with medial plantar flap pedicled with free dorsalis pedis artery can repair soft tissue defect of the palm, and it has many advantages of soft texture, satisfactory function, and small injury at donor site.

Citation： JINWenhu, CHANGShusen, WEIZairong, LIHai, ZHANGZiyang, SUNGuangfeng, WANGBo, TANGXiujun, NIEKaiyu, QIJianping. REPAIR OF PALM SOFT TISSUE DEFECT WITH MEDIAL TARSAL COMBINED WITH MEDIAL PLANTAR FLAP PEDICLED WITH FREE DORSALIS PEDIS ARTERY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(11): 1379-1382. doi: 10.7507/1002-1892.20160283 Copy

1.	黄飞, 李骥, 张发惠, 等.吻合血管的足内侧皮瓣修复手掌软组织缺损.中国修复重建外科杂志, 2008, 22(11): 1404-1405.
2.	牟勇, 黄东, 邹小艳, 等.吻合多穿支血管的足底内侧皮瓣修复手掌软组织缺损八例.中华显微外科杂志, 2015, 38(6): 588-590.
3.	Huang QS, Wu X, Zheng HY, et al. Medial plantar flap to repair defects of palm volar skin. Eur J Trauma Emerg Surg, 2015, 41(3): 293-297.
4.	Lai CH, Lai CS, Huang SH, et al. Free medial plantar artery perforator flaps for the resurfacing of thumb defects. Ann Plast Surg, 2010, 65(6): 535-540.
5.	常鹏, 梁久龙, 时杰, 等.游离足内侧皮瓣在复杂手部皮肤缺损中的应用.中国美容整形外科杂志, 2016, 27(2): 92-94.
6.	陈奇鸣, 罗锦辉, 杨福周, 等.跗内侧游离静脉皮瓣修复手部软组织缺损的临床应用.中华显微外科杂志, 2012, 35(2): 158-160.
7.	潘达德, 顾玉东, 侍德, 等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志, 2000, 16(3): 130-135.
8.	Sato T, Ichioka S. Ostectomy and medial plantar artery flap reconstruction for charcot foot ulceration involving the midfoot. J Foot Ankle Surg, 2016, 55(3): 628-632.
9.	伍辉国, 张文亚, 江克罗, 等.游离足内侧穿支皮瓣修复手掌侧皮肤软组织缺损七例.中华显微外科杂志, 2014, 37(2): 173-175.
10.	唐阳平, 张兴奎, 张桂红, 等.足底内侧皮瓣移植修复足底负重区缺损.实用手外科杂志, 2016, 30(2): 216-218.
11.	金文虎, 孙广峰, 聂开瑜, 等.以足背动脉为蒂逆行跗内侧联合足内侧皮瓣修复足远端软组织缺损十例.中华烧伤杂志, 2014, 30(6): 533-534.
12.	魏在荣, 邵星, 雷国敏, 等.胫前动脉踝上穿支皮瓣的解剖基础及其修复足背动脉缺损的前足创面.中华显微外科杂志, 2012, 35(1): 60-62.
13.	侍朋举, 张文龙, 赵刚, 等.足背皮瓣串并联踇甲复合组织瓣修复手部脱套伤伴拇指缺损.中国修复重建外科杂志, 2015, 29(7): 799-803.
14.	Wu Z, Song D, Lin J, et al. Anatomic basis of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels: a cadaveric dissection. Surg Radiol Anat, 2015, 37(8): 975-981.
15.	欧阳海洋, 牟勇, 吴伟炽, 等.足内侧穿支皮瓣设计的解剖基础.中国临床解剖学杂志, 2014, 32(2): 141-144.
16.	Hayashi A, Matsumura T, Horiguchi M, et al. The medial plantar flap vascularized by the reverse flow lateral plantar artery: a novel variation through the case of aggressive digital papillary adenocarcinoma of the sole. J Reconstr Microsurg, 2012, 28(6): 427-430.
17.	Boffeli TJ, Waverly BJ. Medial and lateral plantar artery angiosome rotational flaps for transmetatarsal and Lisfranc amputation in patients with compromised plantar tissue. J Foot Ankle Surg, 2016, 55(2): 351-361.
18.	吴必华, 覃涵睿, 魏在荣, 等.扩大足底内侧皮瓣对足跟恶性黑色素瘤切除后创面的修复.中国美容整形外科杂志, 2014, 25(3): 132-135.
19.	陈佳, 龙兴敬, 李雪松, 等.吻合皮神经的足底内侧皮瓣修复手掌皮肤缺损.中华骨科杂志, 2014, 34(5): 553-557.
20.	唐举玉, 魏在荣, 张世民, 等.穿支皮瓣的临床应用原则专家共识.中华显微外科杂志, 2016, 39(2):105-106.

1. 黄飞, 李骥, 张发惠, 等.吻合血管的足内侧皮瓣修复手掌软组织缺损.中国修复重建外科杂志, 2008, 22(11): 1404-1405.
2. 牟勇, 黄东, 邹小艳, 等.吻合多穿支血管的足底内侧皮瓣修复手掌软组织缺损八例.中华显微外科杂志, 2015, 38(6): 588-590.
3. Huang QS, Wu X, Zheng HY, et al. Medial plantar flap to repair defects of palm volar skin. Eur J Trauma Emerg Surg, 2015, 41(3): 293-297.
4. Lai CH, Lai CS, Huang SH, et al. Free medial plantar artery perforator flaps for the resurfacing of thumb defects. Ann Plast Surg, 2010, 65(6): 535-540.
5. 常鹏, 梁久龙, 时杰, 等.游离足内侧皮瓣在复杂手部皮肤缺损中的应用.中国美容整形外科杂志, 2016, 27(2): 92-94.
6. 陈奇鸣, 罗锦辉, 杨福周, 等.跗内侧游离静脉皮瓣修复手部软组织缺损的临床应用.中华显微外科杂志, 2012, 35(2): 158-160.
7. 潘达德, 顾玉东, 侍德, 等.中华医学会手外科学会上肢部分功能评定试用标准.中华手外科杂志, 2000, 16(3): 130-135.
8. Sato T, Ichioka S. Ostectomy and medial plantar artery flap reconstruction for charcot foot ulceration involving the midfoot. J Foot Ankle Surg, 2016, 55(3): 628-632.
9. 伍辉国, 张文亚, 江克罗, 等.游离足内侧穿支皮瓣修复手掌侧皮肤软组织缺损七例.中华显微外科杂志, 2014, 37(2): 173-175.
10. 唐阳平, 张兴奎, 张桂红, 等.足底内侧皮瓣移植修复足底负重区缺损.实用手外科杂志, 2016, 30(2): 216-218.
11. 金文虎, 孙广峰, 聂开瑜, 等.以足背动脉为蒂逆行跗内侧联合足内侧皮瓣修复足远端软组织缺损十例.中华烧伤杂志, 2014, 30(6): 533-534.
12. 魏在荣, 邵星, 雷国敏, 等.胫前动脉踝上穿支皮瓣的解剖基础及其修复足背动脉缺损的前足创面.中华显微外科杂志, 2012, 35(1): 60-62.
13. 侍朋举, 张文龙, 赵刚, 等.足背皮瓣串并联踇甲复合组织瓣修复手部脱套伤伴拇指缺损.中国修复重建外科杂志, 2015, 29(7): 799-803.
14. Wu Z, Song D, Lin J, et al. Anatomic basis of the distally based venocutaneous flap on the medial plantar artery of the hallux with medial plantar vein and nutrient vessels: a cadaveric dissection. Surg Radiol Anat, 2015, 37(8): 975-981.
15. 欧阳海洋, 牟勇, 吴伟炽, 等.足内侧穿支皮瓣设计的解剖基础.中国临床解剖学杂志, 2014, 32(2): 141-144.
16. Hayashi A, Matsumura T, Horiguchi M, et al. The medial plantar flap vascularized by the reverse flow lateral plantar artery: a novel variation through the case of aggressive digital papillary adenocarcinoma of the sole. J Reconstr Microsurg, 2012, 28(6): 427-430.
17. Boffeli TJ, Waverly BJ. Medial and lateral plantar artery angiosome rotational flaps for transmetatarsal and Lisfranc amputation in patients with compromised plantar tissue. J Foot Ankle Surg, 2016, 55(2): 351-361.
18. 吴必华, 覃涵睿, 魏在荣, 等.扩大足底内侧皮瓣对足跟恶性黑色素瘤切除后创面的修复.中国美容整形外科杂志, 2014, 25(3): 132-135.
19. 陈佳, 龙兴敬, 李雪松, 等.吻合皮神经的足底内侧皮瓣修复手掌皮肤缺损.中华骨科杂志, 2014, 34(5): 553-557.
20. 唐举玉, 魏在荣, 张世民, 等.穿支皮瓣的临床应用原则专家共识.中华显微外科杂志, 2016, 39(2):105-106.

Chinese Journal of Reparative and Reconstructive Surgery

REPAIR OF PALM SOFT TISSUE DEFECT WITH MEDIAL TARSAL COMBINED WITH MEDIAL PLANTAR FLAP PEDICLED WITH FREE DORSALIS PEDIS ARTERY

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