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.	黃飛, 李驥, 張發惠, 等.吻合血管的足內側皮瓣修復手掌軟組織缺損.中國修復重建外科雜志, 2008, 22(11): 1404-1405.
2.	牟勇, 黃東, 鄒小艷, 等.吻合多穿支血管的足底內側皮瓣修復手掌軟組織缺損八例.中華顯微外科雜志, 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.	常鵬, 梁久龍, 時杰, 等.游離足內側皮瓣在復雜手部皮膚缺損中的應用.中國美容整形外科雜志, 2016, 27(2): 92-94.
6.	陳奇鳴, 羅錦輝, 楊福周, 等.跗內側游離靜脈皮瓣修復手部軟組織缺損的臨床應用.中華顯微外科雜志, 2012, 35(2): 158-160.
7.	潘達德, 顧玉東, 侍德, 等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志, 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.	伍輝國, 張文亞, 江克羅, 等.游離足內側穿支皮瓣修復手掌側皮膚軟組織缺損七例.中華顯微外科雜志, 2014, 37(2): 173-175.
10.	唐陽平, 張興奎, 張桂紅, 等.足底內側皮瓣移植修復足底負重區缺損.實用手外科雜志, 2016, 30(2): 216-218.
11.	金文虎, 孫廣峰, 聶開瑜, 等.以足背動脈為蒂逆行跗內側聯合足內側皮瓣修復足遠端軟組織缺損十例.中華燒傷雜志, 2014, 30(6): 533-534.
12.	魏在榮, 邵星, 雷國敏, 等.脛前動脈踝上穿支皮瓣的解剖基礎及其修復足背動脈缺損的前足創面.中華顯微外科雜志, 2012, 35(1): 60-62.
13.	侍朋舉, 張文龍, 趙剛, 等.足背皮瓣串并聯踇甲復合組織瓣修復手部脫套傷伴拇指缺損.中國修復重建外科雜志, 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.	歐陽海洋, 牟勇, 吳偉熾, 等.足內側穿支皮瓣設計的解剖基礎.中國臨床解剖學雜志, 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.	吳必華, 覃涵睿, 魏在榮, 等.擴大足底內側皮瓣對足跟惡性黑色素瘤切除后創面的修復.中國美容整形外科雜志, 2014, 25(3): 132-135.
19.	陳佳, 龍興敬, 李雪松, 等.吻合皮神經的足底內側皮瓣修復手掌皮膚缺損.中華骨科雜志, 2014, 34(5): 553-557.
20.	唐舉玉, 魏在榮, 張世民, 等.穿支皮瓣的臨床應用原則專家共識.中華顯微外科雜志, 2016, 39(2):105-106.

1. 黃飛, 李驥, 張發惠, 等.吻合血管的足內側皮瓣修復手掌軟組織缺損.中國修復重建外科雜志, 2008, 22(11): 1404-1405.
2. 牟勇, 黃東, 鄒小艷, 等.吻合多穿支血管的足底內側皮瓣修復手掌軟組織缺損八例.中華顯微外科雜志, 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. 常鵬, 梁久龍, 時杰, 等.游離足內側皮瓣在復雜手部皮膚缺損中的應用.中國美容整形外科雜志, 2016, 27(2): 92-94.
6. 陳奇鳴, 羅錦輝, 楊福周, 等.跗內側游離靜脈皮瓣修復手部軟組織缺損的臨床應用.中華顯微外科雜志, 2012, 35(2): 158-160.
7. 潘達德, 顧玉東, 侍德, 等.中華醫學會手外科學會上肢部分功能評定試用標準.中華手外科雜志, 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. 伍輝國, 張文亞, 江克羅, 等.游離足內側穿支皮瓣修復手掌側皮膚軟組織缺損七例.中華顯微外科雜志, 2014, 37(2): 173-175.
10. 唐陽平, 張興奎, 張桂紅, 等.足底內側皮瓣移植修復足底負重區缺損.實用手外科雜志, 2016, 30(2): 216-218.
11. 金文虎, 孫廣峰, 聶開瑜, 等.以足背動脈為蒂逆行跗內側聯合足內側皮瓣修復足遠端軟組織缺損十例.中華燒傷雜志, 2014, 30(6): 533-534.
12. 魏在榮, 邵星, 雷國敏, 等.脛前動脈踝上穿支皮瓣的解剖基礎及其修復足背動脈缺損的前足創面.中華顯微外科雜志, 2012, 35(1): 60-62.
13. 侍朋舉, 張文龍, 趙剛, 等.足背皮瓣串并聯踇甲復合組織瓣修復手部脫套傷伴拇指缺損.中國修復重建外科雜志, 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. 歐陽海洋, 牟勇, 吳偉熾, 等.足內側穿支皮瓣設計的解剖基礎.中國臨床解剖學雜志, 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. 吳必華, 覃涵睿, 魏在榮, 等.擴大足底內側皮瓣對足跟惡性黑色素瘤切除后創面的修復.中國美容整形外科雜志, 2014, 25(3): 132-135.
19. 陳佳, 龍興敬, 李雪松, 等.吻合皮神經的足底內側皮瓣修復手掌皮膚缺損.中華骨科雜志, 2014, 34(5): 553-557.
20. 唐舉玉, 魏在榮, 張世民, 等.穿支皮瓣的臨床應用原則專家共識.中華顯微外科雜志, 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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