Coverage Of Skin Defect Over The Heel

Heel is the major weight-bearing parts of the body, As the anatomical structure and function of the particularity,the keratinous layer of skin and subcutaneous fat are thickness,and a more dense fibrous connective tissue,skin of the heel is thick,tough,wear-resistant pressure and have a good feeling. The coverage of skin defect over the heel has been a problem faced by hand surgeons. 60's heel soft tissue defect of almost all use of cross-leg flap or tubular flap,with the flap technique and advances in microsurgical technique,wound repair for the heel, not only focus only on the function reconstruction,more attention to shape remodeling,and repair methods are constantly increasing. Current clinical use more foot (muscle) flap,leg island flap,free (muscle) skin flaps and so on to repair the plantar soft tissue defect,the reported results are satisfactory.In order to be useful in clinical work, explore the most good method, Find a different effect between repair methods.This Research Object is 11 categories of different soft tissue flap which were adopted by the department of handsurgery of the First Hospital of Jilin University,from 1999 to 2009, through 6 months to 10 years of follow-up visit,we analysis and comparison of 11 types of flaps:sural neurovascular flap (one case carrying the lateral head of gastrocnemius) were 30 cases; Anterolateral leg retrograde island flap 8 cases,medial plantar island flap in 8 cases;Retrograde island flap medial leg in 6 cases;lateral reversed island flap in 9 cases;tensor fascia lata musculocutaneous flap flap in 2 cases;free anterolateral thigh flap in 5 cases;free flap one case of peroneal artery;peroneal artery retrograde island flap 1 case; Dorsal artery antegrade flap in 1 case. A total of 73 heel flap of soft tissue defects. Results:six cases of flap are necrosis in 73 flaps, which sural neurovascular flap necrosis in 3 cases,Anterolateral leg retrograde island flap necrosis in 1 case,necrosis of Retrograde island flap medial leg 1 case,tensor fascia lata musculocutaneous flap flap necrosis in 1 case,16 cases of distal necrosis. Through follow-up we found that the medial plantar flap shape, texture are best,with sensory function,the flap has good adhesion with the calcaneus, after weight-bearing can be formed the thick keratinized epidermis,no frostbite,burns and ulcers. Freeweight of the heel is normal.Free anterolateral thigh flap,free flap skin peroneal artery had no significant keratinization, Surface varying degrees of abrasion,blisters,or ulcers,skin and calcaneal sliding between different degrees affect the full weight-bearing heel. Through the above analysis we conclude:the medial plantar flap with a small defect was the best,but can not meet the large area defect;different forms of leg flap showed no significant difference;Free anterolateral thigh flap for repairing large skin defect,but the feeling of reconstruction more difficult,cumbersome appearance and high incidence of pressure ulcers is a disadvantage.