The Research Division Of Heel And The Clinical Application Of Various Kinds Of Flap In Repairing Defect Of Heel

Objective:To introduce the new method of the division about the heel and to compare the clinical effects of different skin flaps in repairing soft tissue defects of the heel.Methods:Anatomical study of 12 cases of fresh heels without replantation conditions.According to the physiological and anatomical characteristics of the skin around the calcaneus,the heel can be divided into weight-bearing area and non-weight-bearing area.The weight bearing area is located at the bottom of the heel,the non-weight-bearing areas include the medial,the lateral and the posterior to the heel.According to the location,size and shape of heel defect,7 different types of skin flaps were selected for repair,including 6 cases of tibial posterior artery flaps,7 cases of peroneal artery skin flaps,15 cases of sural nerve nutrition skin flaps,7 cases of lateral malleolus perforator skin flaps,5 cases of upper malleolus perforator skin flaps,5 cases of medial plantar skin flaps,and 4 cases of abductor pollicis muscle flaps.Postoperative guidance for patients with early rehabilitation training,follow-up and record relevant data.The function of the hind foot was evaluated by Maryland one year after operation.Results:Follow up ranged from 12 months to 2 years,with an average 13.5 months.Among the 49 flaps,47 flaps were survived completely,the distal epidermis of the 2 flaps is partially necrotic and healed after secondary debridement and dressing change.The appearance,texture,an color of 38 skin flaps in the non-weight-bearing area of the heel were restored well,without ulcers,and the sensory function was partially restored.Among the repaired 11 skin flap in the heel weight-bearing area,2 cases had compression ulcer,and the remaining 9 cases had recover sensory function completely,which were closely attached to the calcaneal and could form proper thickness of stratum corneum.No compression ulcer or other complications occurred after standing.The skin flaps were evaluated using the American orthopaedic foot and ankle association scoring system.The results show that the excellent were 26 cases,good 19 cases,average 3 cases and bad 1 case.The good rate was 91.8 percent.Conclusion: According to the physiological and anatomical characteristics of the skin around the calcaneus,the heel can be divided into weight-bearing area and non-weight-bearing area,which have great significance for the clinical application of skin flap to repair the defects of different area.For the defect of non-weight-bearing area,the result of all kinds of skin flap to repair effect is no significant difference,while for the defect of weight-bearing area,the medial plantar flap and thumb abductor musculocutaneous flap is a good choice,which not only can repair the defect,but also restore the sensory function of the heel,through the nerve conduction to establish coordination reaction,keeping a good balance of the body and making the movement smoothly in standing and walking.