Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jian , ZHENG Yucen , XIAO Shune ,  WEI Zairong , NIE Kaiyu , LIU Zhiyuan , CHANG Shusen , JIN Wenhu , CHEN Wei

Department of Plastic Surgery and Burns, the Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

WEI Zairong, Email: zairongwei@163.com

Keywords：

Plantar medial thin skin flap; plantar fascia; fascial tissue; hand; foot; skin wound repair

DOI：

10.7507/1002-1892.202309050

Video：

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Objective To explore the feasibility and effectiveness of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet. Methods Between July 2017 and January 2023, 35 cases of hand and foot defects were repaired with plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue (13 pedicled flaps and 22 free flaps). There were 18 males and 17 females, with an average age of 38.8 years (range, 8-56 years). Thirty cases of defects were caused by trauma, and the interval between injury and admission ranged from 2 to 6 hours (mean, 3.3 hours). Three cases were ulcer wounds with a course of 3.0, 3.8, and 7.0 months, respectively. Two cases were malignant melanoma. Eight cases of wounds located in the fingers, 13 cases in the palm, 12 cases in the heel, and 2 cases in the distal foot. The size of skin defects ranged from 4.0 cm×3.5 cm to 12.0 cm×10.0 cm, and the size of flap ranged from 5.0 cm×4.5 cm to 13.0 cm×11.0 cm. The donor sites were repaired with skin grafts. Results All flaps were survived and the wounds healed by first intention after operation. The partial necrosis at the edge of the skin graft occurred in 1 case, which healed after dressing change; the other skin grafts survived successfully. All patients were followed up 6-24 months (mean, 18 months). The flaps exhibited similar color and thickness to the surrounding hand and foot skin. Two-point discrimination ranged from 7 to 10 mm in the flaps with an average of 8 mm. The donor sites had no painful scars or sensory abnormalities. Foot and ankle functions were good and gaits were normal. Conclusion Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet had good flap shape, high survival rate of skin graft at the donor site, and no obvious complications.

Citation： ZHOU Jian, ZHENG Yucen, XIAO Shune, WEI Zairong, NIE Kaiyu, LIU Zhiyuan, CHANG Shusen, JIN Wenhu, CHEN Wei. Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1501-1504. doi: 10.7507/1002-1892.202309050 Copy

1.	Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg, 1979, 64(3): 295-298.
2.	魏在荣, 王达利, 王玉明, 等. 足底内侧动脉联合皮瓣的应用解剖及在足跟部较大皮肤软组织缺损修复中的应用. 中华医学杂志, 2009, 89(22): 1553-1557.
3.	王海文, 顾荣, 江新民, 等. 足底内侧动脉穿支皮瓣修复手部掌侧皮肤软组织缺损. 中华显微外科杂志, 2013, 36(5): 486-488.
4.	梁高峰, 张伟, 段超鹏, 等. 游离足底内侧Flow-through皮瓣修复手指软组织缺损12例. 中华显微外科杂志, 2019, 42(4): 411-413.
5.	刘兴明, 唐林, 周鑫, 等. 髂腹股沟皮瓣联合足底内侧动脉穿支皮瓣瓦合修复多指Ⅲ~Ⅳ度缺损. 中国修复重建外科杂志, 2022, 36(6): 1026-1031.
6.	张弓雪, 金文虎, 张子阳, 等. 足底内侧联合足内侧皮瓣修复足底负重区缺损的疗效. 中华创伤杂志, 2023, 39(6): 523-527.
7.	唐林, 周鑫, 黄宇, 等. 踇甲皮瓣联合足底内侧动脉穿支皮瓣瓦合修复长手指脱套伤. 中国修复重建外科杂志, 2022, 36(4): 456-460.
8.	唐修俊, 王达利, 魏在荣, 等. 旋股外侧动脉降支皮瓣的个体化设计与供瓣区的生态保护. 中华整形外科杂志, 2018, 34(7): 509-514.
9.	肖顺娥, 张天华, 吴必华, 等. 薄型游离旋股外侧动脉穿支皮瓣修复手足部瘢痕挛缩畸形. 中国修复重建外科杂志, 2022, 36(2): 220-223.
10.	李红东, 宁金龙. 足底内侧皮瓣修复足跟部黑色素瘤三例. 中华整形外科杂志, 2001, 17(2): 108.
11.	杜全红, 毕卫伟, 仲崇华, 等. 游离足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损的远期随访. 中华显微外科杂志, 2020, 43(4): 357-360.
12.	尹成国, 王业本, 姚保兵, 等. 游离足底内侧静脉皮瓣在手指软组织缺损中的应用. 中华手外科杂志, 2014, 30(6): 470-472.
13.	Kawakatsu M. Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation. J Plast Reconstr Aesthet Surg, 2019, 72(3): 459-466.
14.	张忠, 郑晓菊, 王辉. 废弃足底皮瓣在截肢保膝关节的应用体会. 中华显微外科杂志, 2017, 40(6): 605-607.
15.	刘兴坤, 张永福, 廖健兴, 等. 婴幼儿皮肤毛细血管密度的区域性差异——酶组织化学结合体视学研究. 中华整形烧伤外科杂志, 1998, 14(6): 448-451.
16.	Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg, 2011, 64(2): 248-254.
17.	Yang D, Yang JF, Morris SF, et al. Medial plantar artery perforator flap for soft-tissue reconstruction of the heel. Ann Plast Surg, 2011, 67(3): 294-298.
18.	伍辉国, 张文亚, 江克罗, 等. 游离足内侧穿支皮瓣修复手掌侧皮肤软组织缺损七例. 中华显微外科杂志, 2014, 37(2): 173-175.
19.	孙广峰, 吴祥奎, 聂开瑜, 等. 游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损. 中华手外科杂志, 2017, 33(4): 245-247.
20.	金文虎, 常树森, 魏在荣, 等. 以足背动脉为蒂的跗内侧联合足底内侧游离皮瓣修复手掌部软组织缺损. 中国修复重建外科杂志, 2016, 30(11): 1379-1382.
21.	Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int, 2007, 28(5): 617-620.
22.	Caravaggi P, Pataky T, Günther M, et al. Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis. J Anat, 2010, 217(3): 254-261.
23.	李建新, 邓建林, 张志杰, 等. 肌肉骨骼超声在评估慢性足底筋膜炎中的临床应用. 中国康复, 2012, 27(5): 348-350.
24.	肖亮, 贺光照, 李晶, 等. 自体皮片游离植皮术在难愈性创面治疗中的疗效观察. 重庆医科大学学报, 2013, 38(1): 90-93.

1. Shanahan RE, Gingrass RP. Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg, 1979, 64(3): 295-298.
2. 魏在荣, 王达利, 王玉明, 等. 足底内侧动脉联合皮瓣的应用解剖及在足跟部较大皮肤软组织缺损修复中的应用. 中华医学杂志, 2009, 89(22): 1553-1557.
3. 王海文, 顾荣, 江新民, 等. 足底内侧动脉穿支皮瓣修复手部掌侧皮肤软组织缺损. 中华显微外科杂志, 2013, 36(5): 486-488.
4. 梁高峰, 张伟, 段超鹏, 等. 游离足底内侧Flow-through皮瓣修复手指软组织缺损12例. 中华显微外科杂志, 2019, 42(4): 411-413.
5. 刘兴明, 唐林, 周鑫, 等. 髂腹股沟皮瓣联合足底内侧动脉穿支皮瓣瓦合修复多指Ⅲ~Ⅳ度缺损. 中国修复重建外科杂志, 2022, 36(6): 1026-1031.
6. 张弓雪, 金文虎, 张子阳, 等. 足底内侧联合足内侧皮瓣修复足底负重区缺损的疗效. 中华创伤杂志, 2023, 39(6): 523-527.
7. 唐林, 周鑫, 黄宇, 等. 踇甲皮瓣联合足底内侧动脉穿支皮瓣瓦合修复长手指脱套伤. 中国修复重建外科杂志, 2022, 36(4): 456-460.
8. 唐修俊, 王达利, 魏在荣, 等. 旋股外侧动脉降支皮瓣的个体化设计与供瓣区的生态保护. 中华整形外科杂志, 2018, 34(7): 509-514.
9. 肖顺娥, 张天华, 吴必华, 等. 薄型游离旋股外侧动脉穿支皮瓣修复手足部瘢痕挛缩畸形. 中国修复重建外科杂志, 2022, 36(2): 220-223.
10. 李红东, 宁金龙. 足底内侧皮瓣修复足跟部黑色素瘤三例. 中华整形外科杂志, 2001, 17(2): 108.
11. 杜全红, 毕卫伟, 仲崇华, 等. 游离足底内侧动脉穿支皮瓣修复手指掌侧软组织缺损的远期随访. 中华显微外科杂志, 2020, 43(4): 357-360.
12. 尹成国, 王业本, 姚保兵, 等. 游离足底内侧静脉皮瓣在手指软组织缺损中的应用. 中华手外科杂志, 2014, 30(6): 470-472.
13. Kawakatsu M. Free medialis pedis venous flap transfer for reconstruction of volar finger defects: Clinical application and esthetic evaluation. J Plast Reconstr Aesthet Surg, 2019, 72(3): 459-466.
14. 张忠, 郑晓菊, 王辉. 废弃足底皮瓣在截肢保膝关节的应用体会. 中华显微外科杂志, 2017, 40(6): 605-607.
15. 刘兴坤, 张永福, 廖健兴, 等. 婴幼儿皮肤毛细血管密度的区域性差异——酶组织化学结合体视学研究. 中华整形烧伤外科杂志, 1998, 14(6): 448-451.
16. Oh SJ, Moon M, Cha J, et al. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap. J Plast Reconstr Aesthet Surg, 2011, 64(2): 248-254.
17. Yang D, Yang JF, Morris SF, et al. Medial plantar artery perforator flap for soft-tissue reconstruction of the heel. Ann Plast Surg, 2011, 67(3): 294-298.
18. 伍辉国, 张文亚, 江克罗, 等. 游离足内侧穿支皮瓣修复手掌侧皮肤软组织缺损七例. 中华显微外科杂志, 2014, 37(2): 173-175.
19. 孙广峰, 吴祥奎, 聂开瑜, 等. 游离足底内侧皮瓣修复手掌及腕部大面积皮肤缺损. 中华手外科杂志, 2017, 33(4): 245-247.
20. 金文虎, 常树森, 魏在荣, 等. 以足背动脉为蒂的跗内侧联合足底内侧游离皮瓣修复手掌部软组织缺损. 中国修复重建外科杂志, 2016, 30(11): 1379-1382.
21. Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int, 2007, 28(5): 617-620.
22. Caravaggi P, Pataky T, Günther M, et al. Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis. J Anat, 2010, 217(3): 254-261.
23. 李建新, 邓建林, 张志杰, 等. 肌肉骨骼超声在评估慢性足底筋膜炎中的临床应用. 中国康复, 2012, 27(5): 348-350.
24. 肖亮, 贺光照, 李晶, 等. 自体皮片游离植皮术在难愈性创面治疗中的疗效观察. 重庆医科大学学报, 2013, 38(1): 90-93.

Chinese Journal of Reparative and Reconstructive Surgery

Application of plantar medial thin skin flaps preserving plantar fascia with its superficial fascia tissue to repair skin defects in hands and feet

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