关键词: 康复治疗, 　软组织缺损, 　游离皮瓣, 　创面修复, 　足踝功能

Abstract: Objective　To explore the clinical effect of early rehabilitation training of foot and ankle joint after repairing soft tissue defect with free flap. Methods　A total of 32 patients with foot and ankle soft tissue defects who were treated in our department from January 2018 to January 2022 were selected. The control group included 15 patients who did not receive rehabilitation treatment after free flap transplantation. The observation group consisted of 17 patients who received early rehabilitation training after free flap transplantation. The tissue defect wound of all patients involved ankle joint skin， accompanied by tendon and bone exposure. The area of the patient’s wound after debridement was 7.0 cm×3.0 cm~25.0 cm× 23.0 cm， and the femoral anterolateral free flap was transplanted to repair the wound. The area of skin flap was 9.0 cm×4.0 cm~ 27.0 cm×15.0 cm. The survival of the flap， the healing time of the wound after flap transplantation and the occurrence of complications were recorded. The patients in the observation group began the rehabilitation training of the affected foot 4 days  after operation until they were discharged from hospital. AOFAS scoring system of American Orthopedic Foot and Ankle Association was used to evaluate the function of foot and ankle before operation， 3 weeks after operation and 6 months after operation. Barthel index was used to evaluate the activity of daily living （ADL） of patients before operation， 3 weeks after operation and 6 months after operation. At the same time， patient satisfaction was recorded 6 months after operation. Results　All the 32 flaps survived， while 2 cases in the observation group and 2 cases in the control group had partial tissue necrosis at the edge of the flap， and recovered after dressing change. The wound healing time of the observation group was （16.35±2.83） days， which was less than that of the control group （18.67±3.22） days（ P<0.05）. All patients had good skin flap texture and appearance， and no secondary scar and joint release surgery was performed. No skin ulcers， amputations or deaths occurred during follow-up. There was no significant difference in AOFAS score and ADL score between the observation group and the control group before operation（ P>0.05）. At 3 weeks and 6 months after surgery， AOFAS score and ADL score of foot and ankle function in observation group were significantly higher than those in control group（ P<0.05）. The satisfaction of patients in observation group was slightly higher than that in control group， and the difference was not statistically significant （Z=-0.937， P>0.05）. Conclusion　 The intervention of early rehabilitation training after free skin flap transplantation for soft tissue injury of foot and ankle can significantly improve the joint function of foot and ankle， improve the patients' self-care ability in daily life， and have long-term effects

Key words: 　Rehabilitation treatment, 　Soft tissue defect, 　Free flap, 　Wound repair, 　Ankle function