Objective To evaluate the characteristics, classification, treatment methods, and cl inical outcomes of the spoke heel injuries in children. Methods From June 2001 to June 2008, 289 children with bicycle or motorcycle spoke heel injuries were treated, including 179 males and 110 females aged 2-12 years old (average 3.9 years old). There were 179 cases of skin contusion and laceration (type I), 83 cases of skin and soft tissue defect with Achilles tendon exposure (type II), and 27 cases of wide skin and soft tissue defect with the Achilles tendon defect and rupture (type III). The defect size of the skin or the soft tissues ranged from 3 cm × 2 cm to 11 cm × 7 cm in type II and type III injury. The time between injury and hospital admission was 1-53 days (average 14.5 days). Child patients with type I injury were managed with dressing or suturing after debridement. For the child patients with type II injury, the wound was repaired with the regional fascia flap in 53 cases, the reverse sural neurocutaneous vascular flap in 19 cases, the reverse saphenous neurocutaneous vascular flap in 9 cases, and the lateral supramalleolar flap in 2 cases. For the child patients with type III injury, 6 cases underwent primary repair of the Achilles tendon followed by the transposition of the reverse sural neurocutaneous vascular flap, 3 cases received primary repair of the wound with the reverse sural neurocutaneous vascular flap and secondary reconstruction of the Achilles tendon with the upturned fascia strip or the ipsilateral il iotibial tract transplant, and 18 cases underwent primary repair of the wound and the Achilles tendon with the sl iding bi-pedicled gastrocnemius musculocutaneous flap. The flap size ranged from 4 cm × 2 cm to 30 cm × 12 cm. All the donor sites were closed bypartial suture and spl it-thickness skins graft. The lower l imbs were immobil ized with plaster spl ints after operation. Results All the flaps survived except for 1 case of type II suffering from distal flap venous crisis 3 days after operation and 6 cases of type III suffering from distal flap necrosis 3-5 days after operation. All those flaps survived after symptomatic treatment. All the skin grafts at the donor site survived uneventfully. All the wounds healed by first intention. All child patients were followed up for 15-820 days (average 42 days). Child patients with type I and type II injury had a full recovery of ankle functions. While 25 cases of type III injury had ankle dorsal extension degree loss (10-30°) and unilateral plantar flexion strength decrease 3 months after operationwithout influence on walking, and 2 cases recovered well. Conclusion Spoke heel injury in children has special mec hanisms of injury, and the choice of proper treatment method should be based on the types of injury.
OBJECTIVE: Soft tissue defect of heel is not uncommon. Transplantation of free cutaneous flap and transfer of axial cutaneous flap have been used in treating such defect successfully, but both of them are somewhat complicated. Local plantar rotatory flap might show great importance in this field. METHODS: Since March 1993 to March 1998, 9 cases with soft tissue defect of heel were repaired by local plantar rotation flaps. The size of defect ranged from 2 cm x 4 cm to 6 cm x 8 cm, and it was designed superficial to plantar fascia. The flap was medially based, and nutrilized by proximal plantar subcutaneous plexus of blood supply as well as lateral and medial plantar nerve. RESULTS: Followed up 4 months to 2 years, all the flaps were survived. Sensation of the flap was preserved in 7 patients, who had normal sensation of the donated area preoperatively. The transferred flap was endurable to body bearing. CONCLUSIONS: The flap is easily prepared with reliable blood supply and sensation of the flap preserved. The method is worthy to be recommended for widely use because of its advantages over other methods.
Objective To explore the effect of transferring adjacent non-main vessel pedicle flap on repairing the heel skin defect. Methods From February 2000 to April 2004, 4 kinds of flaps with non-main vessel pedicle were used to repair 30 cases of heel skin defect. Of the 30 patients, 19 were male and 11 were female, whose ages ranged from 8 to 65. Among them, 19 cases were crush injury, 5 cases were press injury, 3 cases were electric saw injury, 2 cases were osteomyelitis, and 1 case was squamous cell carcinoma. Fourteen cases were with defect area ranged from 6.0 cm×5.5 cm to 16.5 cm×11.0 cm. All the 14 cases were repaired with distant pedicled sural vascular flap of nutrient vessels and saphenous vascular flap of nutrient vessels.The sizes of the dissected flap ranged from 6.0 cm×5.0 cm to 18.0 cm×12.0 cm. And the other 16 cases with defect area ranged from 2.5 cm×2.0 cm to 5.5 cm×4.5 cm were repaired with foot lateral flap and foot base medial flap.The sizes of the dissected flap ranged from 4.0 cm×3.0 cm to 8.0 cm×7.0 cm. Results All cases were followed up for 6 to 12 months. The flaps all survived with satisfactory appearance and no ulceration. Callus appeared in 2 cases.The sense of pain and touch was partly or completely restored. The two-point discrimination sense recovered to 1.0-3.2 cm. Conclusion As it is easilyaccessible, highly flexible and causes little damage to blood circulation, transferring adjacent non-main vessel pedicle flap is effective in repairing foot heel skin defect.
OBJECTIVE: To investigate the efficacy of different flaps in the treatment of skin defect of hell. METHODS: Forty-six patients with skin defect of hell were adopted in this study. There were 39 males and 7 females, 29 years old in average. Six different flaps were applied in the reconstructive operation, 14 plantaris medialis flaps, 4 flexor digitorum brevis muscle flaps, 3 abductor hallucis flaps, 7 latissimus dorsi flaps, 16 distal medialis flaps of leg pedicled with the cutaneous branch of posterior fibial artery, 2 foot dorsum flaps. RESULTS: All the flaps survived, primary healing of the wound in 45 cases and secondary healing in 1 case. Followed up for 3 months to 4 years, 43 patients obtained good flap sensation, the function of weight bearing were satisfied in 43 patients. CONCLUSION: The six different flaps should be applied according to patient’s condition individually. The sensation of flap is very important to the function of weight bearing.
OBJECTIVE To research the result of defect repairing on heel with island-shaped fascial flap of lateral foot. METHODS: Twelve cases of soft tissue defected on heel, who were resulted from trauma, chronic ulcer, chronic osteomyelitis, squamous carcinoma, and necrosis following frozen injury, were treated by transfer of island-shaped fasical flap of lateral foot. RESULTS Only 2 patients suffered marginal necrosis of flap in early stage and healed after changing dressing. The others succeeded completely. All the cases were followed up for 8 to 78 months. There was no recurrence of squamous carcinoma, no fistula or necrosis bone formed. The sensation of the flap recovered. The repaired area was similar to the heel in skin texture. CONCLUSION For the characteristics of heel skin, the transfer of island-shaped fascial flap of lateral foot has the following advantages: Similar structure of skin, reliable nerve and blood supply, simple operative techniques, and large area of donor flap.
ObjectiveTo investigate the effectiveness of using a sensory prefabricated flap to repair the heel avulsion injury. MethodsBetween 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. ResultsSix 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. ConclusionFor 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.
Objective To compare the cl inical effectiveness of the medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap in repairing defect caused by resection of cutaneous mal ignant melanoma (CMM) in the heel region. Methods The cl inical data were retrospectively analysed from 24 patients with defect who had CMM in the heel region and were treated by radical excision and flap repairing between March 2007 and March 2010. Defects were repaired with the reverse sural neurocutaneous flaps of 8 cm × 7 cm-14 cm × 12 cm at size in 12 patients (groupA), with the medial plantar flaps of 6 cm × 5 cm-8 cm × 7 cm at size in 7 patients (group B), and with the retrograde posterior tibial vascular flaps of 9 cm × 7 cm-15 cm × 13 cm at size in 5 patients (group C). There was no significant difference in gender, age, duration of illness, cl inical stage, and size of CMM among 3 groups (Pgt; 0.05). The donor site was sutured directly or by free skin graft. Results No significant difference was found in the operation time and the intraoperative blood loss among 3 groups (P gt; 0.05). All skin flaps or grafts survived and wounds healed by first intention. The patients were followed up 1-3 years. The flaps had normal texture and color with no ulcer in 3 groups. At 1 year after operation, the sensory recovery rates of the flaps were 0, 100%, and 20% in groups A, B, and C, respectively, showing significant difference among 3 groups (P=0.001). The patients had normal appearance of heel and pain-free walking [10 (83%) in group A, 6 (86%) in group B, and 4 (80%) in group C] of heel region, showing no significant difference among 3 groups (χ2=40.000, P=0.135). Heel pain existed in weightbearing walking of 3 groups, and there were significant differences in visule analogue scale (VAS) score (Plt; 0.05). There was no significant difference in range of motion of ankle joint among 3 groups (P gt; 0.05). Except 1 patiant of relapse in group A at 1 month after operation, no relapse was observed in the other patients during follow-up. Conclusion The medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap can achieve the good cl inical effectiveness in treating heel defect caused by the resection of CMM. And the medial plantar flap is the first choice in small skin defect of heel area.
Objective To study the surgical resection and reconstruction methods of mal ignant melanoma on the heel. Methods Between July 2007 and June 2009, 15 cases of mal ignant melanoma on the heel were treated. There were 9 males and 6 females, aged from 32 to 71 years with a mean age of 47.2 years. Of them, 13 patients were initially treated, and 2 patients received repair after local excision. Tumor thickness was from 0.6 mm to 7.2 mm, and the size of the lesion was from 1.3 cm × 0.5 cm to 5.0 cm × 3.5 cm. According to the American Joint Committee on Cancer (AJCC) stage system, there were 1 case of IA, 2 cases of IB, 3 cases of IIA, 5 cases of IIB, 1 case of IIC, and 3 cases of III. Wide excision was performed in all cases. Defects were repaired by medial pedal skin flap (5 cases), lateral pedal skin flap (2 cases), and retrograde skin flap suppl ied by sural nutrition blood vessels (8 cases), and the flap size ranged from 7 cm × 5 cm to 12 cm × 8 cm. Inguinal lymph node dissection was performed in 3 patients. Wounds of donor site were repaired by skin graft. Results One case had marginal necrosis of lateral pedal skin flap and 2 cases had local necrosis of medial pedal skin flap on the skin graft; the other flaps and skin grafts survived and incisions healed by first intention. All patients were followed up from 12 to 36 months (mean, 21 months). Considering the recovery of the function and sense, the best result was acquired in the lateral pedal skin flap, followed by the medial pedal skin flap, and the poor result in the retrograde skin flap suppl ied by sural nutrition blood vessel. No patient had local recurrence at follow-up. Five patients had inguinal lymph node metastasis, and 1 patient died of lung metastasis. Conclusion Wide resection can provide satisfactory local control for mal ignant melanoma on the heel. Local flap can cover the wound safely, but the retrograde skin flap suppl ied by sural nutrition blood vessel has poor sensory recovery.
OBJECTIVE To investigate the repairing method of soft tissue defect of heel, pedicled island myocutaneous flap of flexor digitorum brevis was designed. METHODS From 1984 to 1997, 26 cases with soft tissue defect of heel were adopted in the clinical trial. Among them, the were 18 males, 8 females and the age ranged from 15 to 60 years old. The area of wound ranged from 2.5 cm x 1.5 cm to 8.0 cm x 6.0 cm. RESULTS After operation, all of the flaps survived. They were followed up for 9 to 72 months. All of the flaps had primary healing except in one there was infection of peripheral of the flap. The contour of heel was satisfactory the sensation of flap was good and the weight-bearing function was also successful. CONCLUSION It was concluded that the myocutaneous flap of flexor digitorum brevis could be used to repair the soft tissue defect of heel because of its nearby position, hidden location, good recovery of skin sensation and weight-bearing function, Besides, the procedure of this operation was simple and the anti-inflammatory potential of the flap was high. However, Because of the limited donor area, the pre-operative design was important.
OBJECTIVE The repair of soft tissue defect of heel by traditional operation did not restore the sensation of the heel. METHODS In order to solve this problem, the saphenous neurovascular skin flap reinnervated by end-to-side neuro-anastomosis was designed and 3 male patients with soft tissue defects of the heel were so treated. Grossgraft of saphenous neurovascular skin flap was employed for repairing the soft tissue defects of heel and the pedicle was divided at 21 days after operation. The end-to-side neuro-anastomosis was used to reinnervate not only the skim flap, but also the skin area of the medial malleolus, medial aspect of the foot and the big toe of the donor limb. RESULTS After follow-up of 6-12 months, the walking and weight bearing functions of the affected limbs were good, the contour of the grafted area was satisfactory, and the recovery of sensation of the skin flap, the medial malleolus, the medial aspect of the foot and the big toe was observed. CONCLUSION 1. Crossgraft of the saphenous skin flap was an effective method to repair the soft tissue defect of the heel; 2. End-to-side neuro-anastomosis could restore the sensation of the skin flap.