RECONSTRUCTION OF AVULSED INJURIES OF HEEL WITH A SENSORY PREFABRICATED FLAP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAOGuangchao ¹ ,  ZHENGDawei ¹ , SUNFeng ¹ , SHOUKuishui ²

1. Department of Hand Surgery, Xuzhou Renci Hospital, Xuzhou Jiangsu, 221000, P. R. China;
2. Department of Hand Surgery, Wuxi Hand Surgery Hospital;

Corresponding?author：

ZHENGDawei, Email: davyzheng93006@163.com

Keywords：

Heel avulsed wound; Prefabricated sensory flap; Wound repair

DOI：

10.7507/1002-1892.20150043

Video：

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Objective To investigate the effectiveness of using a sensory prefabricated flap to repair the heel avulsion injury. Methods Between August 2012 and August 2013, 6 cases of heel avulsion injury were treated. There were 4 males and 2 females, aged 16-54 years (mean, 29 years). The causes were crush injury in 4 cases and wheel twist injury in 2 cases. The injury to admission time was 2-6 hours (mean, 4 hours). The size of skin avulsion ranged from 5 cm×3 cm to 15 cm×8 cm. Avulsion skin had no replanted condition. At one stage operation, the avulsed heel skin soft tissue was made the full thickness skin graft which was fostered on the anterolateral thigh with lateral circumflex femoral artery perforator, and the lateral femoral cutaneous nerve was put beneath the skin to prefabricate the prefabricated flap; at two stage operation, the prefabricated skin flap pedicled with lateral circumflex femoral artery was used to repair the wound, and the lateral femoral nerve was anastomosed with the calcaneal nerve to reconstruct the feeling. Results Six prefabricated flaps all survived, and re-plantation flaps survived after operation. The wounds healed by first intention at donor site and recipient site. The patients were followed up 1-2 years (mean, 1.5 years). The flaps had satisfactory appearance and soft texture. At 1 year after operation, the sensation of the flaps was S3, with two-point discrimination of 22-27 mm (mean, 24.3 mm). According to ZHANG Ming's evaluation standards, the results were excellent in 5 cases, and good in 1 case. The patients could walk normally or with weight-bearing; only linear scar formed at the donor site. Conclusion For patients with heel soft tissue avulsion injury without replantation qualification, a sensory prefabricated flap by the avulsed heel skin soft tissue can transplanted to repair the heel defect. Satisfactory effectiveness can be obtained in heel appearance and function recovery.

Citation： CAOGuangchao, ZHENGDawei, SUNFeng, SHOUKuishui. RECONSTRUCTION OF AVULSED INJURIES OF HEEL WITH A SENSORY PREFABRICATED FLAP. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 198-201. doi: 10.7507/1002-1892.20150043 Copy

1.	Yan H, Liu S, Gao W, et al. Management of degloving injuries of the foot with a dafatted full-thickness skin graft. J Bone Joint Surg (Am), 2013, 95(18):1675-1681.
2.	劉宇舟. 足跟皮膚撕脫再植一例. 中國修復重建外科雜志, 2011, 25(1):103.
3.	滕國棟, 湯海萍, 陳淑琴, 等. 足部組織缺損修復516例回顧性分析. 中華顯微外科雜志, 2014, 37(3):295-297.
4.	滕國棟, 湯海萍, 袁光海, 等. 應用足底內側動脈皮瓣修復跟腱部皮膚缺損. 中華顯微外科雜志, 2012, 35(2):147-148.
5.	姚俊娜, 趙祚塨, 杜志軍, 等. 脛后動脈穿支皮瓣在足跟部軟組織缺損修復中的應用. 中華顯微外科雜志, 2014, 37(2):176-178.
6.	王劍利, 王成琪, 付興茂, 等. 預制皮瓣修復足底負重區軟組織缺損. 中國修復重建外科雜志, 2002, 16(3):177-178.
7.	鄭曉菊, 王保山, 王新宏, 等. 股前外側皮瓣分層應用修復手足撕脫傷. 中華手外科雜志, 2012, 28(2):121-122.
8.	章鳴, 郭翱, 劉升輝, 等. 皮瓣修復足跟軟組織缺損療效的研究. 中華顯微外科雜志, 2009, 32(6):458-460.
9.	Hoang NT, Kloeppel M, Werner J, et al. Proposed new method for angiographically quantifying neovascularization in prefabricated flaps. Microsurg, 2005, 25(3):220-226.
10.	張功林, 章鳴, 蔡國榮, 等. 足跟預制皮瓣移植修復足跟缺損二例. 中華顯微外科雜志, 2008, 31(3):187.
11.	Guo L, Pribaz JJ. Clinical flap prefabrication. Plast Reconstr Surg, 2009, 124(6 Suppl):e340-e350.
12.	Hoang NT, Staudenmaier R, Luu HH, et al. Successful re-construction of a large tissue defect using a free pre-fabricated flap with purely implanted arterialised venous loop. J Plast Reconstr Aest Surg, 2009, 62(7):e225-e228.
13.	Yan H, He Z, Li Z, et al. Large prefabricated skin flaps based on the venous system in rabbits:a preliminary study. Plast Reconstr Surg, 2013, 132(3):372e-380e.
14.	唐舉玉, 李康華, 吳梅英, 等. 股外側皮神經和跟內、外側神經的截面形態觀察與神經纖維計數. 中華顯微外科雜志, 2009, 32(1):47-50.
15.	Dellon AL. Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation. Plast Reconstr Surg, 2002, 109(7):2313-2324.
16.	Grothaus MC, Holt M, Mekhail AO, et al. Lateral femoral cutaneous nerve:an anatomic study. Clin Orthop Relat Res, 2005, (437):164-168.
17.	de Ridder VA, de Lange S, Popta JV, et al. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma, 1999, 13(3):207-211.
18.	唐舉玉, 李康華, 任家伍, 等. 股外側皮神經的形態特點與臨床意義. 中南大學學報:醫學版, 2012, 37(12):1255-1259.

1. Yan H, Liu S, Gao W, et al. Management of degloving injuries of the foot with a dafatted full-thickness skin graft. J Bone Joint Surg (Am), 2013, 95(18):1675-1681.
2. 劉宇舟. 足跟皮膚撕脫再植一例. 中國修復重建外科雜志, 2011, 25(1):103.
3. 滕國棟, 湯海萍, 陳淑琴, 等. 足部組織缺損修復516例回顧性分析. 中華顯微外科雜志, 2014, 37(3):295-297.
4. 滕國棟, 湯海萍, 袁光海, 等. 應用足底內側動脈皮瓣修復跟腱部皮膚缺損. 中華顯微外科雜志, 2012, 35(2):147-148.
5. 姚俊娜, 趙祚塨, 杜志軍, 等. 脛后動脈穿支皮瓣在足跟部軟組織缺損修復中的應用. 中華顯微外科雜志, 2014, 37(2):176-178.
6. 王劍利, 王成琪, 付興茂, 等. 預制皮瓣修復足底負重區軟組織缺損. 中國修復重建外科雜志, 2002, 16(3):177-178.
7. 鄭曉菊, 王保山, 王新宏, 等. 股前外側皮瓣分層應用修復手足撕脫傷. 中華手外科雜志, 2012, 28(2):121-122.
8. 章鳴, 郭翱, 劉升輝, 等. 皮瓣修復足跟軟組織缺損療效的研究. 中華顯微外科雜志, 2009, 32(6):458-460.
9. Hoang NT, Kloeppel M, Werner J, et al. Proposed new method for angiographically quantifying neovascularization in prefabricated flaps. Microsurg, 2005, 25(3):220-226.
10. 張功林, 章鳴, 蔡國榮, 等. 足跟預制皮瓣移植修復足跟缺損二例. 中華顯微外科雜志, 2008, 31(3):187.
11. Guo L, Pribaz JJ. Clinical flap prefabrication. Plast Reconstr Surg, 2009, 124(6 Suppl):e340-e350.
12. Hoang NT, Staudenmaier R, Luu HH, et al. Successful re-construction of a large tissue defect using a free pre-fabricated flap with purely implanted arterialised venous loop. J Plast Reconstr Aest Surg, 2009, 62(7):e225-e228.
13. Yan H, He Z, Li Z, et al. Large prefabricated skin flaps based on the venous system in rabbits:a preliminary study. Plast Reconstr Surg, 2013, 132(3):372e-380e.
14. 唐舉玉, 李康華, 吳梅英, 等. 股外側皮神經和跟內、外側神經的截面形態觀察與神經纖維計數. 中華顯微外科雜志, 2009, 32(1):47-50.
15. Dellon AL. Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation. Plast Reconstr Surg, 2002, 109(7):2313-2324.
16. Grothaus MC, Holt M, Mekhail AO, et al. Lateral femoral cutaneous nerve:an anatomic study. Clin Orthop Relat Res, 2005, (437):164-168.
17. de Ridder VA, de Lange S, Popta JV, et al. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma, 1999, 13(3):207-211.
18. 唐舉玉, 李康華, 任家伍, 等. 股外側皮神經的形態特點與臨床意義. 中南大學學報:醫學版, 2012, 37(12):1255-1259.

Chinese Journal of Reparative and Reconstructive Surgery

RECONSTRUCTION OF AVULSED INJURIES OF HEEL WITH A SENSORY PREFABRICATED FLAP

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