Repair of cicatricial contracture deformity of palm with modified free medial plantar flap with preserved abductor hallucis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ziyang ,  TANG Xiujun , WEI Zairong , JIN Wenhu , SUN Guangfeng , DENG Chengliang , LI Hai , LI Shujun

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

Corresponding author：

TANG Xiujun, Email: xiujunsszx@163.com

Keywords：

Medial plantar flap; scar contracture; wound repair; abductor hallucis

DOI：

10.7507/1002-1892.201801141

Video：

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Objective To investigate the effectiveness of modified free medial plantar flap with preserved abductor hallucis for repairing cicatricial contracture deformity of palm. Methods Between January 2012 and July 2017, a modified free medial plantar flap with preserved abductor hallucis was used to repair 9 cases of cicatricial contracture deformity at the palm. There were 7 males and 2 females with a median age of 23 years old (range, 15-40 years). The duration of cicatricial contracture was 4-23 years (mean, 9 years). In addition, 3 cases had combined stiffness of finger joints, 2 cases of tendon exposure, and 2 cases with exposed tendon and nerve. The range of flap was 4.5 cm×4.0 cm to 8.0 cm×6.0 cm. The vessel pedicle of the flap was 7-8 cm in length, with an average length of 7.5 cm. Grafting and repairing were performed with full-thickness skin graft from the ilioinguinal region in the donor site. Results All flaps and skin grafts survived after operation, and all wounds healed at first intention. All 9 patients were followed up 5-22 months (mean, 10 months). The flap exhibited smooth appearance and soft texture, which was similar to that of the normal skin around. The recovery time of dermal sensation was 5-12 months (mean, 9 months). At last follow-up, the flap recovered to level S₄ in 5 cases, level in 2 cases, and level S₃ in 2 cases. The two-point discrimination was 6.0-10.0 mm (mean, 8.5 mm). According to the assessment of the upper limb function issued by the Hand Surgery Society of Chinese Medical Association, the hand function was excellent in 5 cases, good in 2 cases, and fair in 2 cases. Additionally, the abduction and flexion activities of the great toe of the donor foot were not affected, and the skin grafting area was slightly colored. Conclusion The modified free medial plantar flap for repairing cicatricial contracture deformity of palm has such advantages as no impact on abductor hallucis, small damage of the donor area, improved survival rate of skin grafting, and the unaffected function of the donor foot.

Citation： ZHANG Ziyang, TANG Xiujun, WEI Zairong, JIN Wenhu, SUN Guangfeng, DENG Chengliang, LI Hai, LI Shujun. Repair of cicatricial contracture deformity of palm with modified free medial plantar flap with preserved abductor hallucis. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(7): 951-954. doi: 10.7507/1002-1892.201801141 Copy

1.	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.
2.	金文虎, 常树森, 魏在荣, 等. 以足背动脉为蒂的跗内侧联合足底内侧游离皮瓣修复手掌部软组织缺损. 中国修复重建外科杂志, 2016, 30(11): 1379-1382.
3.	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.
4.	张字, 高秋明, 邓银栓, 等. 中外文献对足底内侧动脉分支描述差异的分析. 中国临床解剖学杂志, 2015, 33(1): 21-23.
5.	丛海波, 余志平, 丁英杰, 等. 游离足内侧皮瓣修复指掌侧皮肤缺损 17 例. 中华显微外科杂志, 2015, 38(5): 469-471.
6.	王海文, 顾荣, 江新民, 等. 足底内侧动脉穿支皮瓣修复手部掌侧皮肤软组织缺损. 中华显微外科杂志, 2013, 36(5): 486-488.
7.	王守道, 史增元, 尹维刚, 等. 足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖. 中国临床解剖学杂志, 2014, 32(4): 381-383.
8.	李丹, 惠瑞, 韩岩. 足底内侧皮瓣游离移植修复足底创面. 中华整形外科杂志, 2017, 33(3): 196-199.
9.	Beidas OE, Tan BK, Petersen JD. The rotational advancement of medial plantar flap for coverage of foot defect: a case report. Microsurgery, 2012, 32(4): 322-325.
10.	孙广峰, 吴祥奎, 聂开瑜, 等. 游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损. 中华手外科杂志, 2017, 33(4): 245-247.
11.	Yang D, Yang JF, Morris SF, et al. Medial plantar artery perforator flap for soft-tissue reconstruction of the heel. Ann Plast Surg, 2011, 67(3): 294-298.
12.	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.
13.	吴春, 谭莉, 应建军, 等. 吻合浅静脉的足底内侧游离皮瓣修复手掌皮肤软组织缺损. 中华手外科杂志, 2017, 33(3): 230-231.
14.	Tsai J, Liao HT, Ulusal BG, et al. Modified retrograde-flow medial plantar island flap for reconstruction of distal dorsal forefoot defects--two case reports. Microsurgery, 2010, 30(2): 146-150.
15.	邹勇, 邹文, 刘容珍, 等. 扩大的足底内侧动脉皮瓣修复创伤性足跟软组织缺损. 中华损伤与修复杂志 (电子版), 2014, 9(5): 40-42.
16.	Jyoshid RB, Vardhan H, Anto F. Free medial plantar artery flap for the reconstruction of great toe pulp. J Plast Reconstr Aesthet Surg, 2014, 67(6): 863-865.
17.	Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg, 2010, 64(2): 248-254.
18.	许亚军, 周晓, 柯尊山, 等. 不同穿支蒂足(底)内侧逆行岛状皮瓣修复前足底软组织缺损. 中华显微外科杂志, 2012, 35(6): 501-502.
19.	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.
20.	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.

1. 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.
2. 金文虎, 常树森, 魏在荣, 等. 以足背动脉为蒂的跗内侧联合足底内侧游离皮瓣修复手掌部软组织缺损. 中国修复重建外科杂志, 2016, 30(11): 1379-1382.
3. 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.
4. 张字, 高秋明, 邓银栓, 等. 中外文献对足底内侧动脉分支描述差异的分析. 中国临床解剖学杂志, 2015, 33(1): 21-23.
5. 丛海波, 余志平, 丁英杰, 等. 游离足内侧皮瓣修复指掌侧皮肤缺损 17 例. 中华显微外科杂志, 2015, 38(5): 469-471.
6. 王海文, 顾荣, 江新民, 等. 足底内侧动脉穿支皮瓣修复手部掌侧皮肤软组织缺损. 中华显微外科杂志, 2013, 36(5): 486-488.
7. 王守道, 史增元, 尹维刚, 等. 足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖. 中国临床解剖学杂志, 2014, 32(4): 381-383.
8. 李丹, 惠瑞, 韩岩. 足底内侧皮瓣游离移植修复足底创面. 中华整形外科杂志, 2017, 33(3): 196-199.
9. Beidas OE, Tan BK, Petersen JD. The rotational advancement of medial plantar flap for coverage of foot defect: a case report. Microsurgery, 2012, 32(4): 322-325.
10. 孙广峰, 吴祥奎, 聂开瑜, 等. 游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损. 中华手外科杂志, 2017, 33(4): 245-247.
11. Yang D, Yang JF, Morris SF, et al. Medial plantar artery perforator flap for soft-tissue reconstruction of the heel. Ann Plast Surg, 2011, 67(3): 294-298.
12. 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.
13. 吴春, 谭莉, 应建军, 等. 吻合浅静脉的足底内侧游离皮瓣修复手掌皮肤软组织缺损. 中华手外科杂志, 2017, 33(3): 230-231.
14. Tsai J, Liao HT, Ulusal BG, et al. Modified retrograde-flow medial plantar island flap for reconstruction of distal dorsal forefoot defects--two case reports. Microsurgery, 2010, 30(2): 146-150.
15. 邹勇, 邹文, 刘容珍, 等. 扩大的足底内侧动脉皮瓣修复创伤性足跟软组织缺损. 中华损伤与修复杂志 (电子版), 2014, 9(5): 40-42.
16. Jyoshid RB, Vardhan H, Anto F. Free medial plantar artery flap for the reconstruction of great toe pulp. J Plast Reconstr Aesthet Surg, 2014, 67(6): 863-865.
17. Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg, 2010, 64(2): 248-254.
18. 许亚军, 周晓, 柯尊山, 等. 不同穿支蒂足(底)内侧逆行岛状皮瓣修复前足底软组织缺损. 中华显微外科杂志, 2012, 35(6): 501-502.
19. 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.
20. 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.

Chinese Journal of Reparative and Reconstructive Surgery

Repair of cicatricial contracture deformity of palm with modified free medial plantar flap with preserved abductor hallucis

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