Clinical categorization and microsurgical reconstructive algorithm for complex tissue defects of the ankle and foot
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摘要: 足踝部解剖结构特殊,承担重要的人体负重、行走、跑跳等功能,高能损伤后伤情复杂,临床组织重建困难。足踝部复杂组织缺损多表现为累及皮肤软组织、肌腱、骨、关节等多元组织的缺损和巨大面积的皮肤软组织缺损。笔者根据足踝部各区域解剖特点与生理功能,将该部位划分为9个区域,然后根据组织缺损累及区域的不同和是否合并深部组织缺损,将该部位缺损划分为10种临床类型。对于每一种临床类型,都可依据其显微重建要求的不同选择合适的皮瓣供区和适宜的特殊形式穿支皮瓣术式,以实现个性化精准重建,达到以最小的供区损害获得最佳的足踝部外形与功能的恢复。Abstract: The ankle and foot have a special anatomical structure and undertake crucial functions of body such as weight bearing, walking, running, and jumping. High-energy injuries often lead to complicated conditions and pose challenges to clinical tissue reconstruction. Complex tissue defects of the ankle and foot mostly present as multicompartmental defects involving skin and soft tissue, tendons, bones, and joints, as well as large-area skin and soft tissue defects. We divided the ankle and foot into nine regions based on the anatomical characteristics and physiological functions of different sites. Ten clinical types were then classified according to the involved regions of tissue defects and the presence of combined deep tissue defects. For each clinical type, appropriate flap donor sites and suitable special form of perforator flap procedures can be selected based on the requirements of microsurgical reconstruction, so as to achieve personalized and precise reconstruction and obtain optimal restoration of the appearance and function of the ankle and foot with minimal donor-site morbidities.
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Key words:
- Foot /
- Ankle /
- Perforator flap /
- Microsurgery /
- Tissue defects /
- Clinical categorization /
- Personalized reconstruction
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参考文献
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图 2 采用显微削薄-分叶腹壁下动脉穿支皮瓣修复患儿Ⅰ型右足踝部复杂组织缺损的效果。2A.术前见右足背、踝部大面积皮肤软组织缺损并骨关节外露,累及Ⅰ区、Ⅲ区和Ⅳ区；2B.皮瓣设计；2C.皮瓣切取完成即刻；2D.皮瓣削薄后即刻；2E.皮瓣移植后即刻；2F.皮瓣血液循环重建示意图；2G.皮瓣供区直接闭合后即刻；2H.术后1年皮瓣供区恢复情况；2I、2J.分别为术后1年足部背伸、屈曲情况,踝关节屈伸功能恢复良好
图 3 采用重建感觉的显微削薄旋股外侧动脉降支穿支皮瓣整复患者右足外伤后瘢痕挛缩伴踝关节背伸障碍、足跟溃疡的效果。3A、3B.分别为瘢痕切除前足外侧观、足底观；3C、3D.分别为切除瘢痕组织后足内侧观、外侧观,可见皮肤软组织缺损累及Ⅴ区、Ⅵ区、Ⅷ区,为Ⅳ型右足踝部复杂组织缺损；3E.皮瓣设计；3F.皮瓣切取中；3G.覆盖跟后区皮瓣去脂后即刻；3H、3I、3J.分别为皮瓣移植术后即刻足内侧观、足外侧观与足底观,受区外形与血运良好；3K.皮瓣血液循环重建示意图；3L.皮瓣供区美容缝合后即刻；3M、3N、3O.分别为皮瓣移植术后18个月足内侧观、足外侧观与足底观,受区外形良好；3P.术后18个月皮瓣供区恢复良好
图 4 采用血流桥接-显微削薄-分叶-嵌合旋股外侧动脉降支穿支皮瓣修复患者Ⅷ型右足踝部复杂组织缺损的效果。4A、4B、4C.分别为术前足内侧观、足后侧观、足外侧观,可见皮肤软组织缺损合并部分跟骨缺损,累及Ⅱ区、Ⅳ区、Ⅴ区、Ⅵ区,局部存在深部无效腔；4D.皮瓣设计；4E、4F.分别为皮瓣切取与显微削薄、皮瓣拼接；4G、4H、4I.分别为皮瓣移植术后足内侧观、足底观、足外侧观,受区血运良好；4J.皮瓣血液循环重建示意图；4K.皮瓣供区美容缝合后即刻；4L、4M、4N.分别为皮瓣移植术后24个月足内侧观、足后侧观、足外侧观,受区外形良好；4O.术后24个月皮瓣供区恢复良好
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