EFFECTIVENESS OF REPAIRING OR RECONSTRUCTING DEFECTS OF FOREFOOT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGZhihao , DINGYingjie , YUZhiping , WANGXiaoke , XINGGuofei ,  CONGHaibo

Department of Orthopedics, Weihai Central Hospital, Weihai Shandong, 264400, P. R. China;

Corresponding?author：

CONGHaibo, Email: haibocong@163.com

Keywords：

Forefoot; Destructive injury; Bone defect; Wound repair

DOI：

10.7507/1002-1892.20160035

Video：

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Objective To evaluate the effectiveness of repairing or reconstructing defects of the forefoot. Methods Between February 2006 and February 2013, 57 patients with defects of the forefoot were treated. There were 41 males and 16 females with an average age of 38.9 years (range, 19-68 years). The disease causes included motor vehicles crush injury in 28 cases, crashing injury in 17 cases, and machine extrusion injury in 12 cases. The left side was involved in 25 cases and the right side in 32 cases, with a mean disease duration of 4.7 hours (range, 0.5-75.0 hours). Defect located at the 1st metatarsus in 9 cases, at the 5th metatarsus in 8 cases, at the 1st and the 2nd metatarsus in 16 cases, at the 4th and 5th metatarsus in 11 cases, at multiple metatarsus and the forefoot in 13 cases. The bone defect ranged from 2.5 cm×1.9 cm×1.4 cm to 13.3 cm×11.2 cm×2.7 cm. The soft tissue defect ranged from 12.4 cm×6.3 cm to 27.2 cm×18.7 cm. The iliac bone or vascularized iliac bone or vascularized fibula bone was used to rebuild the arch of the foot, and free flap was used to repair defects of the forefoot. The donor site was sutured directly or covered with skin graft. Results Venous crisis and partial necrosis occurred in 3 and 2 flaps respectively, which healed after symptomatic treatment. The other flaps and grafted skins survived, and wounds healed primarily. Fifty-one cases were followed up 1.5-2.5 years (mean, 2.1 years). The appearance was excellent and the feeling of the flap recovered at different levels. The two-point discrimination was 8.4-19.8 mm (mean, 13.7 mm) at 1.5 years after operation. According to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, sensation recovered to S₂ in 6 cases, to S₃ in 18 cases, and to S₄ in 27 cases. The patients began to walk with weight loading at 2-6 months after operation (mean, 3.9 months). The bone healing time was 3-6 months (mean, 4.2 months). Based on American Orthopaedic Foot and Ankle Society (AOFAS) standards, the results were excellent in 19 cases, good in 24 cases, fair in 7 case, and poor in 1 case, and the excellent and good rate was 84.3%. Conclusion It is a good solution to treat defects of the forefoot to use iliac bone or vascularized iliac bone or vascularized fibula bone for rebuilding the arch of the foot and use free flap for repairing defect.

Citation： WANGZhihao, DINGYingjie, YUZhiping, WANGXiaoke, XINGGuofei, CONGHaibo. EFFECTIVENESS OF REPAIRING OR RECONSTRUCTING DEFECTS OF FOREFOOT. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 169-172. doi: 10.7507/1002-1892.20160035 Copy

1.	?潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
2.	洪勁松, 付小勇, 孫占東, 等. 復雜中足損傷分型治療的初步探討. 中國骨與關節外科, 2012, 5(4):320-324.
3.	韓興妤, 錢煥娟, 馮亞高. 封閉式負壓引流聯合皮瓣修復足部創面的護理. 實用手外科雜志, 2014, 28(3):346-347.
4.	李亮, 劉寶恒, 陳先禮, 等. 持續負壓封閉引流技術在復雜創傷治療中的應用. 實用手外科雜志, 2011, 25(1):61-63.
5.	叢海波, 王曉科, 丁英杰, 等. 組織瓣移植結合骨搬運修復重建小腿大范圍復合組織缺損. 中華創傷骨科雜志, 2014, 16(6):461-464.
6.	Beidas OE, Tan BK, Petersen JD. The rotational advancement of medial plantar flap for coverageof foot defect:a case report. Microsurgery, 2012, 32(4):322-325.
7.	尹光明. 逆行足背動脈蒂跗外側動脈皮瓣修復前足內側皮膚軟組織缺損. 創傷外科雜志, 2012, 14(2):153-156.
8.	Xu YQ, Zhu YL, Wu NX, et al. Distal foot coverage with reverse dorsal pedal neurocutaneous flaps. J Plast Reconstr Aesthet Surg, 2010, 63(1):164-169.
9.	楊慶達, 梁波, 蘇瑞鑒, 等. 趾底內側動脈皮穿支血管蒂隱神經營養血管逆行皮瓣修復前足皮膚缺損. 中國修復重建外科雜志, 2011, 25(3):379-380.
10.	闞利民, 孟小光, 陳江華. 低旋轉點腓腸神經營養血管皮瓣修復前足軟組織缺損. 中國修復重建外科雜志, 2013, 27(4):509-510.
11.	El-Gammal TA, El-Sayed A, Kotb MM, et al. Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children. Microsurgery, 2013, 33(4):259-264.
12.	壽建國. 帶蒂胸臍皮瓣在修復前臂創面中的臨床應用. 實用骨科雜志, 2015, 21(8):737-738.
13.	侯瑞興, 王天亮, 熊勝, 等. 游離皮瓣延遲修復手背熱壓傷療效觀察. 中國修復重建外科雜志, 2013, 27(3):304-307.
14.	叢海波, 杜全紅, 隋海明, 等. 游離微型腓動脈穿支皮瓣修復前足皮膚缺損. 中華顯微外科雜志, 2013, 36(5):496-498.
15.	叢海波, 隋海明, 李金晟. 組織移植受區可供吻合血管的解決方法. 中華顯微外科雜志, 2000, 23(2):104-106.
16.	鄭大偉, 黎章燦, 許立, 等. Flow-through靜脈皮瓣在伴環形缺損斷指再植中的應用. 中國修復重建外科雜志, 2014, 28(8):977-980.
17.	王劍利, 付興茂, 王成琪, 等. 足前部組織缺損再造修復一些問題的探討. 中華創傷骨科雜志, 2002, 4(2):130-132, 153.
18.	蔡錦方. 足外側縱弓缺失重建的個性化設計. 中國矯形外科雜志, 2013, 21(6):531-532.
19.	吳水培, 俞立新, 黃飛, 等. 足前部毀損傷早期修復重建的臨床研究. 中華創傷雜志, 2002, 18(12):735-736.

1. ?潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
2. 洪勁松, 付小勇, 孫占東, 等. 復雜中足損傷分型治療的初步探討. 中國骨與關節外科, 2012, 5(4):320-324.
3. 韓興妤, 錢煥娟, 馮亞高. 封閉式負壓引流聯合皮瓣修復足部創面的護理. 實用手外科雜志, 2014, 28(3):346-347.
4. 李亮, 劉寶恒, 陳先禮, 等. 持續負壓封閉引流技術在復雜創傷治療中的應用. 實用手外科雜志, 2011, 25(1):61-63.
5. 叢海波, 王曉科, 丁英杰, 等. 組織瓣移植結合骨搬運修復重建小腿大范圍復合組織缺損. 中華創傷骨科雜志, 2014, 16(6):461-464.
6. Beidas OE, Tan BK, Petersen JD. The rotational advancement of medial plantar flap for coverageof foot defect:a case report. Microsurgery, 2012, 32(4):322-325.
7. 尹光明. 逆行足背動脈蒂跗外側動脈皮瓣修復前足內側皮膚軟組織缺損. 創傷外科雜志, 2012, 14(2):153-156.
8. Xu YQ, Zhu YL, Wu NX, et al. Distal foot coverage with reverse dorsal pedal neurocutaneous flaps. J Plast Reconstr Aesthet Surg, 2010, 63(1):164-169.
9. 楊慶達, 梁波, 蘇瑞鑒, 等. 趾底內側動脈皮穿支血管蒂隱神經營養血管逆行皮瓣修復前足皮膚缺損. 中國修復重建外科雜志, 2011, 25(3):379-380.
10. 闞利民, 孟小光, 陳江華. 低旋轉點腓腸神經營養血管皮瓣修復前足軟組織缺損. 中國修復重建外科雜志, 2013, 27(4):509-510.
11. El-Gammal TA, El-Sayed A, Kotb MM, et al. Dorsal foot resurfacing using free anterolateral thigh (ALT) flap in children. Microsurgery, 2013, 33(4):259-264.
12. 壽建國. 帶蒂胸臍皮瓣在修復前臂創面中的臨床應用. 實用骨科雜志, 2015, 21(8):737-738.
13. 侯瑞興, 王天亮, 熊勝, 等. 游離皮瓣延遲修復手背熱壓傷療效觀察. 中國修復重建外科雜志, 2013, 27(3):304-307.
14. 叢海波, 杜全紅, 隋海明, 等. 游離微型腓動脈穿支皮瓣修復前足皮膚缺損. 中華顯微外科雜志, 2013, 36(5):496-498.
15. 叢海波, 隋海明, 李金晟. 組織移植受區可供吻合血管的解決方法. 中華顯微外科雜志, 2000, 23(2):104-106.
16. 鄭大偉, 黎章燦, 許立, 等. Flow-through靜脈皮瓣在伴環形缺損斷指再植中的應用. 中國修復重建外科雜志, 2014, 28(8):977-980.
17. 王劍利, 付興茂, 王成琪, 等. 足前部組織缺損再造修復一些問題的探討. 中華創傷骨科雜志, 2002, 4(2):130-132, 153.
18. 蔡錦方. 足外側縱弓缺失重建的個性化設計. 中國矯形外科雜志, 2013, 21(6):531-532.
19. 吳水培, 俞立新, 黃飛, 等. 足前部毀損傷早期修復重建的臨床研究. 中華創傷雜志, 2002, 18(12):735-736.

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Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF REPAIRING OR RECONSTRUCTING DEFECTS OF FOREFOOT

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