| Objective:To summarize surgical experience of application of 6 kinds of cutaneous faps in repairing soft tissue defect in heel and to explore the indications and characteristic of this cutaneous flaps.Method:To retrospecte and analyse the information about the clinical application of the 6 kinds of cutaneous flaps in repairing soft tissue defect in heel of 107 patients from Auguest 2000 to March 2009.67 cases of sural neurofasciocutaneous flaps were used to repair soft tissue defects in heel. The size was about 3.0cm×6.0cm～20.0cm×15.0cm.The defect involved in the lateral heel region,the posterior,the medial,the heel.25 cases involved in only one repair region,40 cases in two and 2 cases in three.10 cases combined with a dead cavity in heel with distal adipofascial flaps.13 cases were innervated with the anastomosis of the sural nerve to the cutaneous nerve of recipient site.16 cases of septocutaneous perforators fasciocutaneous flaps of posterior tibial artery were used.The size was about 7.0cm×3.0cm～18.0cm×9.0cm.12 cases involved in one repair region,and only 4 cases nvolved in two repair region.9 cases of the reversed island flaps pedicled with the posterior tibial artery were used. The size was about 12.0cm×9.0cm～19.0cm×14.0cm.The defect involve in the heel,the lateral,the medial and the posterior heel region about 6 cases.The defect involve in anterior pedal about 2 cases.The defect involve in the full pedal only 1 cases.6 lateral pedal flaps and 3 medial plantar skin flaps and 6 free flaps were used to repair soft tissue defects in heel.The area,the length,the width of flaps and the fascial pedicle of the first three kinds of flaps were analyzed.Statistics analytical method:t-test and chi square test are used for analysis.Result:89 of the 107 flaps survived uneventfully,distal partly necrosis took place in 5 flaps,distal superficial necrosis in 7 flaps and epidermal necrosis in 6 flaps.56 of the 67 sural neurofasciocutaneous flaps survived uneventfully,distal superficial necrosis in 3 flaps and epidermal necrosis in 4 flaps,1 flap wew partial necrosis,and then septocutaneous perforators fasciocutaneous flap was used to cover the wound.13 of 16 septocutaneous perforators fasciocutaneous flaps survived uneventfully,2 flaps superficial necrosis and 1 epidermal necrosis.6 of the 9 the reversed island flaps survived uneventfully,1 flaps superficial necrosis and 2 epidermal necrosis.5 of the 6 lateral pedal flaps survived uneventfully,1 partial necrosis then covered the wound surfaces by the other flap.3 medial plantar skin flaps survived uneventfully.5 of 6 free flaps survived uneventfully,only 1 flaps superficial necrosis.Whose wound surfaces healed when the 107 patients leave hospital by changing dressings, secondary suture,skin grafting.Through 2 weeks to 47 months follow up, the 107 flaps survived well,and there were neither relapse of suppuration nor the formation of ulcers and pressure sores.The patients of lateral pedal flaps were fully suit the former size shoes.The average area,length,width of the reversed island flaps was the largest in the sural neurofasciocutaneous flaps and the septocutaneous perforators fasciocutaneous flaps(P＜0.05).Conclusion:①The sural neurofasciocutaneous flap can repair most of the defect in heel with the medium size.The distally based sural neurofasciocutaneous flap with distal adipofascial flap is suitable to repair soft tissue defect in heel with a cavity.The advantage of the flap is easy to annihilate suppurative wound and reserve the function of heel's weight loading part.②The fasciocutaneous flap pedicled with the septocutaneous perforators of the posterior tibial artery is suitable for the small and medium size defects located at the the medial heel region.③The reversed island flaps pedicled with the posterior tibial artery is particularly suitable for repairing the defects located at the posterior heel and involved in anterior plantar with large size.④The lateral pedal flaps is particularly suitable for repairing the defects located at the lateral or posterior heel region with small size. |
