中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (06) : 491 -497. doi: 10.3877/cma.j.issn.1673-9450.2024.06.007 × 扫一扫
论著
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Qiufang Gao1, Wanfeng Zhang1,†(), Quanyin Sheng1, Bin Ma1
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高秋芳, 张万锋, 盛泉音, 马彬. 足底内侧皮瓣联合腓动脉穿支皮瓣修复足跟部巨大恶性黑色素瘤切除后创面的临床效果[J]. 中华损伤与修复杂志(电子版), 2024, 19(06): 491-497.
Qiufang Gao, Wanfeng Zhang, Quanyin Sheng, Bin Ma. Clinical effect of medial plantar flap combined with peroneal artery perforator flap in repairing the wound after resection of giant malignant melanoma on heel[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(06): 491-497.
目的
探讨足底内侧皮瓣联合腓动脉穿支皮瓣修复足跟部巨大恶性黑色素瘤切除后创面的效果。
方法
回顾性分析2015 年5 月至2023 年5 月汉中市中心医院烧伤与创面修复科收治的符合纳入与排除标准的9 例足跟部巨大恶性黑色素瘤患者临床资料。 其中男7 例，女2 例，年龄46～72岁。患者均接受肿瘤扩大切除术，手术切缘均为阴性，形成创面面积为8 cm×9 cm～12 cm×14 cm，均采用足底内侧皮瓣联合腓动脉穿支皮瓣修复。 其中足底内侧皮瓣用于修复足跟负重区，切取范围为5 cm×6 cm～9 cm×11 cm；腓动脉穿支皮瓣用于覆盖非负重区，切取范围为10 cm×18 cm～13 cm×24 cm。皮瓣供区创面均采用断层皮片移植修复。 记录术后皮瓣及植皮成活情况，末次随访时记录皮瓣外观，测量皮瓣两点辨别觉距离，采用Maryland 足功能评分评价患足功能。
结果
8 例皮瓣成活良好，1 例腓动脉穿支皮瓣远端部分坏死，清创后移植全厚皮片修复；供瓣区植皮均成活良好。 随访6～36 个月，局部无复发，远位未发现转移。 皮瓣均不臃肿，质地及色泽良好，足底内侧皮瓣感觉正常，两点辨别觉距离3～6 mm，腓动脉穿支皮瓣两点辨别觉距离8～10 mm。 供瓣区植皮残留瘢痕对足功能无明显影响。 末次随访时Maryland 足功能评分为（93.2±6.8）分，优7 例，良2 例。 患者对术区外观满意，术侧下肢功能未受明显影响。
结论
采用足底内侧皮瓣联合腓动脉穿支皮瓣修复足跟部巨大恶性黑色素瘤切除后创面，可同时满足足跟部负重区功能及感觉恢复和非负重区皮瓣覆盖及外形需求，术后外观及功能良好。
Objective
To explore the effect of medial plantar flap combined with peroneal artery perforator flap in repairing the wound after resection of giant malignant melanoma on heel.
Methods
The clinical data of 9 patients with giant malignant melanoma on heel who met the inclusion and exclusion criteria and were admitted to the Department of Burn and Wound Repair， Hanzhong Central Hospital from May 2015 to May 2023 were retrospectively analyzed， including 7 males and 2 females， aged from 46 to 72 years.All patients were enlarged tumor resection， and the surgical margin was negative， and the area of wound ranged from 8 cm×9 cm to 12 cm×14 cm.The medial plantar flap was used to reconstruct the weight-bearing area，the flap area ranged from 5 cm×6 cm to 9 cm×11 cm.The peroneal artery perforator flap was used to cover the non-weight-bearing area， the flap area ranged from 10 cm×18 cm to 13 cm×24 cm.The survival of the flap and skin grafts were recorded.At the last follow-up， the appearance of the flap was recorded， the twopoint discrimination distance of the flap was measured，and the foot function was evaluated by Maryland foot function score.
Results
The flaps of 8 patients survived well， the peroneal artery perforator flap of one patient was partially necrotic， which was reconstructed with full thickness free skin graft after debridement.The patients were followed up for 6-36 months， no local recurrence or distant transfer was found， the flaps were not bloated， the texture and color were good.The medial plantar flap had normal sensation and the twopoint discrimination distance was 3-6 mm.The peroneal artery perforator flap had a two-point discrimination distance of 8-10 mm.The residual scar of skin graft in the donor site had no significant effect on foot function.The Maryland foot function score was （93.2±6.8）， 7 patients were excellent and 2 patients were good.The patients were satisfied with the appearance， and the function of the lower limb was not affected.
Conclusion
The medial plantar flap combined with peroneal artery perforator flap used in repairing the wounds after the resection of giant malignant melanoma on heel， can not only meet the functional and sensory recovery of the weight-bearing area，but also meet the needs of the skin flap coverage and appearance of the non-weight-bearing area of the heel.The postoperative appearance and function are good， and the method is simple and safe.