Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jian , ZHENG Yucen , XIAO Shune ,  WEI Zairong , NIE Kaiyu , LIU Zhiyuan , CHANG Shusen , JIN Wenhu , CHEN Wei

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

Corresponding?author：

WEI Zairong, Email: zairongwei@163.com

Keywords：

Plantar medial thin skin flap; plantar fascia; fascial tissue; hand; foot; skin wound repair

DOI：

10.7507/1002-1892.202309050

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the feasibility and effectiveness of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet. Methods Between July 2017 and January 2023, 35 cases of hand and foot defects were repaired with plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue (13 pedicled flaps and 22 free flaps). There were 18 males and 17 females, with an average age of 38.8 years (range, 8-56 years). Thirty cases of defects were caused by trauma, and the interval between injury and admission ranged from 2 to 6 hours (mean, 3.3 hours). Three cases were ulcer wounds with a course of 3.0, 3.8, and 7.0 months, respectively. Two cases were malignant melanoma. Eight cases of wounds located in the fingers, 13 cases in the palm, 12 cases in the heel, and 2 cases in the distal foot. The size of skin defects ranged from 4.0 cm×3.5 cm to 12.0 cm×10.0 cm, and the size of flap ranged from 5.0 cm×4.5 cm to 13.0 cm×11.0 cm. The donor sites were repaired with skin grafts. Results All flaps were survived and the wounds healed by first intention after operation. The partial necrosis at the edge of the skin graft occurred in 1 case, which healed after dressing change; the other skin grafts survived successfully. All patients were followed up 6-24 months (mean, 18 months). The flaps exhibited similar color and thickness to the surrounding hand and foot skin. Two-point discrimination ranged from 7 to 10 mm in the flaps with an average of 8 mm. The donor sites had no painful scars or sensory abnormalities. Foot and ankle functions were good and gaits were normal. Conclusion Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet had good flap shape, high survival rate of skin graft at the donor site, and no obvious complications.

Citation： ZHOU Jian, ZHENG Yucen, XIAO Shune, WEI Zairong, NIE Kaiyu, LIU Zhiyuan, CHANG Shusen, JIN Wenhu, CHEN Wei. Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1501-1504. doi: 10.7507/1002-1892.202309050 Copy

1.	Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg, 1979, 64(3): 295-298.
2.	魏在榮, 王達利, 王玉明, 等. 足底內側動脈聯合皮瓣的應用解剖及在足跟部較大皮膚軟組織缺損修復中的應用. 中華醫學雜志, 2009, 89(22): 1553-1557.
3.	王海文, 顧榮, 江新民, 等. 足底內側動脈穿支皮瓣修復手部掌側皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(5): 486-488.
4.	梁高峰, 張偉, 段超鵬, 等. 游離足底內側Flow-through皮瓣修復手指軟組織缺損12例. 中華顯微外科雜志, 2019, 42(4): 411-413.
5.	劉興明, 唐林, 周鑫, 等. 髂腹股溝皮瓣聯合足底內側動脈穿支皮瓣瓦合修復多指Ⅲ~Ⅳ度缺損. 中國修復重建外科雜志, 2022, 36(6): 1026-1031.
6.	張弓雪, 金文虎, 張子陽, 等. 足底內側聯合足內側皮瓣修復足底負重區缺損的療效. 中華創傷雜志, 2023, 39(6): 523-527.
7.	唐林, 周鑫, 黃宇, 等. 踇甲皮瓣聯合足底內側動脈穿支皮瓣瓦合修復長手指脫套傷. 中國修復重建外科雜志, 2022, 36(4): 456-460.
8.	唐修俊, 王達利, 魏在榮, 等. 旋股外側動脈降支皮瓣的個體化設計與供瓣區的生態保護. 中華整形外科雜志, 2018, 34(7): 509-514.
9.	肖順娥, 張天華, 吳必華, 等. 薄型游離旋股外側動脈穿支皮瓣修復手足部瘢痕攣縮畸形. 中國修復重建外科雜志, 2022, 36(2): 220-223.
10.	李紅東, 寧金龍. 足底內側皮瓣修復足跟部黑色素瘤三例. 中華整形外科雜志, 2001, 17(2): 108.
11.	杜全紅, 畢衛偉, 仲崇華, 等. 游離足底內側動脈穿支皮瓣修復手指掌側軟組織缺損的遠期隨訪. 中華顯微外科雜志, 2020, 43(4): 357-360.
12.	尹成國, 王業本, 姚保兵, 等. 游離足底內側靜脈皮瓣在手指軟組織缺損中的應用. 中華手外科雜志, 2014, 30(6): 470-472.
13.	Kawakatsu M. Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation. J Plast Reconstr Aesthet Surg, 2019, 72(3): 459-466.
14.	張忠, 鄭曉菊, 王輝. 廢棄足底皮瓣在截肢保膝關節的應用體會. 中華顯微外科雜志, 2017, 40(6): 605-607.
15.	劉興坤, 張永福, 廖健興, 等. 嬰幼兒皮膚毛細血管密度的區域性差異——酶組織化學結合體視學研究. 中華整形燒傷外科雜志, 1998, 14(6): 448-451.
16.	Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg, 2011, 64(2): 248-254.
17.	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.
18.	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.
19.	孫廣峰, 吳祥奎, 聶開瑜, 等. 游離足底內側皮瓣修復手掌及腕部大面積皮膚缺損. 中華手外科雜志, 2017, 33(4): 245-247.
20.	金文虎, 常樹森, 魏在榮, 等. 以足背動脈為蒂的跗內側聯合足底內側游離皮瓣修復手掌部軟組織缺損. 中國修復重建外科雜志, 2016, 30(11): 1379-1382.
21.	Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int, 2007, 28(5): 617-620.
22.	Caravaggi P, Pataky T, Günther M, et al. Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis. J Anat, 2010, 217(3): 254-261.
23.	李建新, 鄧建林, 張志杰, 等. 肌肉骨骼超聲在評估慢性足底筋膜炎中的臨床應用. 中國康復, 2012, 27(5): 348-350.
24.	肖亮, 賀光照, 李晶, 等. 自體皮片游離植皮術在難愈性創面治療中的療效觀察. 重慶醫科大學學報, 2013, 38(1): 90-93.

1. Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg, 1979, 64(3): 295-298.
2. 魏在榮, 王達利, 王玉明, 等. 足底內側動脈聯合皮瓣的應用解剖及在足跟部較大皮膚軟組織缺損修復中的應用. 中華醫學雜志, 2009, 89(22): 1553-1557.
3. 王海文, 顧榮, 江新民, 等. 足底內側動脈穿支皮瓣修復手部掌側皮膚軟組織缺損. 中華顯微外科雜志, 2013, 36(5): 486-488.
4. 梁高峰, 張偉, 段超鵬, 等. 游離足底內側Flow-through皮瓣修復手指軟組織缺損12例. 中華顯微外科雜志, 2019, 42(4): 411-413.
5. 劉興明, 唐林, 周鑫, 等. 髂腹股溝皮瓣聯合足底內側動脈穿支皮瓣瓦合修復多指Ⅲ~Ⅳ度缺損. 中國修復重建外科雜志, 2022, 36(6): 1026-1031.
6. 張弓雪, 金文虎, 張子陽, 等. 足底內側聯合足內側皮瓣修復足底負重區缺損的療效. 中華創傷雜志, 2023, 39(6): 523-527.
7. 唐林, 周鑫, 黃宇, 等. 踇甲皮瓣聯合足底內側動脈穿支皮瓣瓦合修復長手指脫套傷. 中國修復重建外科雜志, 2022, 36(4): 456-460.
8. 唐修俊, 王達利, 魏在榮, 等. 旋股外側動脈降支皮瓣的個體化設計與供瓣區的生態保護. 中華整形外科雜志, 2018, 34(7): 509-514.
9. 肖順娥, 張天華, 吳必華, 等. 薄型游離旋股外側動脈穿支皮瓣修復手足部瘢痕攣縮畸形. 中國修復重建外科雜志, 2022, 36(2): 220-223.
10. 李紅東, 寧金龍. 足底內側皮瓣修復足跟部黑色素瘤三例. 中華整形外科雜志, 2001, 17(2): 108.
11. 杜全紅, 畢衛偉, 仲崇華, 等. 游離足底內側動脈穿支皮瓣修復手指掌側軟組織缺損的遠期隨訪. 中華顯微外科雜志, 2020, 43(4): 357-360.
12. 尹成國, 王業本, 姚保兵, 等. 游離足底內側靜脈皮瓣在手指軟組織缺損中的應用. 中華手外科雜志, 2014, 30(6): 470-472.
13. Kawakatsu M. Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation. J Plast Reconstr Aesthet Surg, 2019, 72(3): 459-466.
14. 張忠, 鄭曉菊, 王輝. 廢棄足底皮瓣在截肢保膝關節的應用體會. 中華顯微外科雜志, 2017, 40(6): 605-607.
15. 劉興坤, 張永福, 廖健興, 等. 嬰幼兒皮膚毛細血管密度的區域性差異——酶組織化學結合體視學研究. 中華整形燒傷外科雜志, 1998, 14(6): 448-451.
16. Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg, 2011, 64(2): 248-254.
17. 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.
18. 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.
19. 孫廣峰, 吳祥奎, 聶開瑜, 等. 游離足底內側皮瓣修復手掌及腕部大面積皮膚缺損. 中華手外科雜志, 2017, 33(4): 245-247.
20. 金文虎, 常樹森, 魏在榮, 等. 以足背動脈為蒂的跗內側聯合足底內側游離皮瓣修復手掌部軟組織缺損. 中國修復重建外科雜志, 2016, 30(11): 1379-1382.
21. Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int, 2007, 28(5): 617-620.
22. Caravaggi P, Pataky T, Günther M, et al. Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis. J Anat, 2010, 217(3): 254-261.
23. 李建新, 鄧建林, 張志杰, 等. 肌肉骨骼超聲在評估慢性足底筋膜炎中的臨床應用. 中國康復, 2012, 27(5): 348-350.
24. 肖亮, 賀光照, 李晶, 等. 自體皮片游離植皮術在難愈性創面治療中的療效觀察. 重慶醫科大學學報, 2013, 38(1): 90-93.

Chinese Journal of Reparative and Reconstructive Surgery

Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content