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.	刘宇舟. 足跟皮肤撕脱再植一例. 中国修复重建外科杂志, 2011, 25(1):103.
3.	滕国栋, 汤海萍, 陈淑琴, 等. 足部组织缺损修复516例回顾性分析. 中华显微外科杂志, 2014, 37(3):295-297.
4.	滕国栋, 汤海萍, 袁光海, 等. 应用足底内侧动脉皮瓣修复跟腱部皮肤缺损. 中华显微外科杂志, 2012, 35(2):147-148.
5.	姚俊娜, 赵祚塨, 杜志军, 等. 胫后动脉穿支皮瓣在足跟部软组织缺损修复中的应用. 中华显微外科杂志, 2014, 37(2):176-178.
6.	王剑利, 王成琪, 付兴茂, 等. 预制皮瓣修复足底负重区软组织缺损. 中国修复重建外科杂志, 2002, 16(3):177-178.
7.	郑晓菊, 王保山, 王新宏, 等. 股前外侧皮瓣分层应用修复手足撕脱伤. 中华手外科杂志, 2012, 28(2):121-122.
8.	章鸣, 郭翱, 刘升辉, 等. 皮瓣修复足跟软组织缺损疗效的研究. 中华显微外科杂志, 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.	张功林, 章鸣, 蔡国荣, 等. 足跟预制皮瓣移植修复足跟缺损二例. 中华显微外科杂志, 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.	唐举玉, 李康华, 吴梅英, 等. 股外侧皮神经和跟内、外侧神经的截面形态观察与神经纤维计数. 中华显微外科杂志, 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.	唐举玉, 李康华, 任家伍, 等. 股外侧皮神经的形态特点与临床意义. 中南大学学报:医学版, 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. 刘宇舟. 足跟皮肤撕脱再植一例. 中国修复重建外科杂志, 2011, 25(1):103.
3. 滕国栋, 汤海萍, 陈淑琴, 等. 足部组织缺损修复516例回顾性分析. 中华显微外科杂志, 2014, 37(3):295-297.
4. 滕国栋, 汤海萍, 袁光海, 等. 应用足底内侧动脉皮瓣修复跟腱部皮肤缺损. 中华显微外科杂志, 2012, 35(2):147-148.
5. 姚俊娜, 赵祚塨, 杜志军, 等. 胫后动脉穿支皮瓣在足跟部软组织缺损修复中的应用. 中华显微外科杂志, 2014, 37(2):176-178.
6. 王剑利, 王成琪, 付兴茂, 等. 预制皮瓣修复足底负重区软组织缺损. 中国修复重建外科杂志, 2002, 16(3):177-178.
7. 郑晓菊, 王保山, 王新宏, 等. 股前外侧皮瓣分层应用修复手足撕脱伤. 中华手外科杂志, 2012, 28(2):121-122.
8. 章鸣, 郭翱, 刘升辉, 等. 皮瓣修复足跟软组织缺损疗效的研究. 中华显微外科杂志, 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. 张功林, 章鸣, 蔡国荣, 等. 足跟预制皮瓣移植修复足跟缺损二例. 中华显微外科杂志, 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. 唐举玉, 李康华, 吴梅英, 等. 股外侧皮神经和跟内、外侧神经的截面形态观察与神经纤维计数. 中华显微外科杂志, 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. 唐举玉, 李康华, 任家伍, 等. 股外侧皮神经的形态特点与临床意义. 中南大学学报:医学版, 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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