| With the continuous development of society, the use of motor vehicles increased rapidly?Mechanization and automation has gradually infiltrated every corner of society.While the high-energy trauma are also increasing year by year, heel injury has been grown.Foot have many variety of functions,such as weight-bearing walking and shock absorption. The foot which implements many functions depends on the functions of heel.Once the heel is damaged, many functions of foot will be lost. And heel structure has its particularity, which has a thick stratum corneum of skin and subcutaneous fat pad with a wear-resistant, voltage characteristics and load-bearing functions.The shape of the heel is not only to facilitate the shoes, but also beautiful. So once the injury caused by local defects, skip texture must be similar in order to maintain good function and morphology, tissue defect of heel, however there is no similar repair Materials.Traditional treatment methods has high disability. It is helpless rather than neglected on functional and morphological reconstruction. With the continuous development of microsurgical technique, a variety of pedicled flaps and free flaps, muscle flaps have been used in clinical, the wound repair problem of soft tissue defect of heel has been resolved basically. However, the existing flaps lack of necessary protection feeling, not to resist pressure and wear-resistant, easy to cause frayed, scald, frostbite and secondary ulcers, and weight-bearing walking instability,seriously affect the function of foot.To sum up,the restruction of function and morphology is difficult probelem for heel defect.At the initial treatment of heel injury, when having been encountered that the skin is still intact, but local conditions are poor, non-available for anastomosis of blood vessels and sensory nerve, almost all surgeons will select abandoned this heel organize in vitro, but we foresee precisely it irreplaceable to restore function and morphology of the heel , which carried out our research.The studies include prefabricating heel flaps in vitro to the anterolateral thigh and returning in order to repair soft tissue defect of heel and restore their functions.The anatomical research is about the dissetion of anterolateral thigh and heel including blood vessels, nerves and soft tissue.Then, on this basis, the technology of saving the left skin to the anerolateral thigh and then returning was introduced.At last, effect of this method was analyzed by comparing to the normal heel and control group.Results:The location of lateral femoral circumflex artery descending branch, anterolateral femoral cutaneous nerve, posterior tibial vessels and sural nerve is constant ,which have thick diameter. It is easy to anastomose. Returning prefabricated flaps cound be able to make the appearance of original surface near normal. After 6-18 months of initial follow-up, 5 patients all cound walk and have daily life. All the patients walked more than half a year without one patients had ulcers of weight-bearing areas prefabricated flaps of the Suffered foot, The stratum corneum of skin patches basic restored to normal status after the next four weeks of going out of bed. The study group was better than the control group on the heel reconstruction of appearance and function by comparison.Conclusion:The district of heel has thick fat pad and thick skin cuticle. The area has a high requirements to the flap donor site. Tensor fascia lata of anterolateral thigh and its deep fascia has a rich vascular network, it is easy to survive the heel skin. For patients who are in line with the indications, the technology of saving the left skin to the anterolateral thigh and returning wound can make to maximize function and morphology of recovery. It also could solve the problem of bloated appearance and bad feeling ,and prevent the occurrence of ulcers and the second operation. However, the prefabricated flap surgery have disadvantages of narrow surgical indications , long time to repair, the second phase surgery, and so on. |
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