An innovative design for reconstruction of plantar heel by split partially overlapping anterolateral thigh flap
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Vigneswaran N & H. W. Ng & Y. M. Samuel Ho & S. Y. Michelle Ho & T. C. Marcus Wong & Guan-Ming Feng & Sheng-Fa Yao & Hsing-Kuang Lai & Patel Hasu &
- چاپ و سال / کشور: 2010
Description
Introduction Reconstruction of the weight bearing, thick and durable heel, in soft tissue injuries of the foot remains a difficult and challenging problem. The thick glabrous epidermis and dermis, and the fibrous septae of the subcutaneous layer provide unique properties for withstanding pressure and shock associated with gait. Materials and Methods Here, the authors put forward an innovative method for a one-stage reconstruction of the weight bearing heel using a partially overlapping split anterolateral thigh perforator flap in a patient with a degloving injury of the foot. Results The patient was allowed partial weight bearing at one month and full weight bearing at two months postoperatively. Sensation tested using Semmes-Weinstein filaments was noted at six months, and at two years revealed 12-mm two-point discrimination of her normal heel and 15-mm two-point discrimination of her reconstructed heel. No ulcerations of the flap were observed at two years. Discussion There are a myriad of choices to reconstruct the hindfoot, which include local, distant and free flaps. Microvascular reconstruction is required for more extensive defects of the foot. The ideal reconstruction should achieve durable coverage, adequate contour and solid anchoring to resist shearing forces and to withstand weight bearing. We advocate the use of the split overlapping anterolateral thigh perforator flap when two reliable perforators can be identified and the patient desires a one stage procedure, in selected cases of complex defects of the heel and sole, without the need for debulking. This restores foot function, has minimal donor-site morbidity and achieves satisfactory long-term functional results.
Eur J Plast Surg DOI 10.1007/s00238-010-0472-y Received: 21 March 2010 / Accepted: 23 June 2010
