Application Of Improved Island Skin Flap Pedicled By Medial Plantar Artery And Nerve To Repair Of The Soft Tissue Defects Of The Heel

Objective: at present,there are many methods to repair the soft tissue of heel,but it is better to choose the island flap with medial plantar neurovascular pedicle because of its tough tissue,wear-resistance and pressure resistance,good sense of recipient site and good clinical effect.However,after the follow-up,it is found that the ability of foot picking and sliding is significantly weakened in the postoperative patients,especially in rainy and snowy days,which is due to the hypoesthesia of the great toe.In view of this situation,the author designs and improves the island flap with medial plantar neurovascular pedicle,in order to explore the reasons for the weakness of the foot pick and slide ability and the hypoesthesia of big finger,so as to make up for the shortcomings of the traditional island flap with medial plantar neurovascular pedicle.Method: four foot specimens are used for related anatomical study,to explore the direction and distribution of the medial plantar neurovascular pedicle,especially the branches and rules of the nerves,so as to prepare for the design of improved medical plantar neurovascular island flap.The traditional island flap with medial plantar neurovascular pedicle needs to cut off the internal and external proper nerves of the first toe plantar in order to obtain a long enough pedicle,so as to transfer and repair the defect of heel soft tissue.The designed improved island flap with medial plantar neurovascular pedicle: preserve the medial plantar neurovascular island flap in plantar proper nerve of the great toe.And select 12 patients with heel defect from September 2017 to August 2019 to study the postoperative sensory recovery of the great toe;the great toe on the affected side is the experimental group;the great toe on the healthy side is the control group.The postoperative recovery of sensory function is evaluated by two-point discrimination and tuning fork vibration sense.The patients are followed up for 6-12 months,and the data of the postoperative second,fourth and sixth months are statistically analyzed.Result: all of the 12 cases are treated with the improved island flap pedicled with the medial plantar neurovascular pedicle to repair heel soft tissue defect,all flaps and donor sites survived in the 12 cases.There is one case of tension blisters on the far side of the flap,but it does not affect the survival of the flap.The patients are followed up for 6-12 months,and collect the data through two-point discrimination and "Y" shaped steel tuning fork test.The ?X±S values in the experimental group were 10.99±1.17,10.36±1.17 and 9.44±1.15 at 2,4 and 6 months after operation respectively according to the statistical analysis.In the control group,the ?X±S values were 10.10±0.88,10.49±1.27 and 9.90±1.33 at 2,4 and 6 months after operation respectively.The experimental group and the control group were matched and compared at 2,4 and 6 months after operation respectively,and P values were P < 0.05,P > 0.05,P > 0.05 respectively.The results showed that there was significant difference between the experimental group and the control group at 2 months after operation,but no significant difference at 4 months and 6 months respectively after operation.and the tuning fork vibration sense is the same or similar.Conclusion: there are obvious advantages in repairing the soft tissue defect of the heel by using the improved island flap with medial plantar neurovascular pedicle,that is to say,the island flap with plantar neurovascular pedicle that retains the medial proper nerve of the first toe,it can cover and repair the wound,preserve the sensation and motor function of the patients' toes,the postoperative sensation of the great toe in the donor area recovers well without obvious influence on the ability to pick and slide;in addition,the operation is simple,so it is worth popularizing and widely applying in clinic.