组织工程与重建外科杂志 ›› 2025, Vol. 21 ›› Issue (4): 331-.

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逆行足底内侧皮瓣修复前足底创面后感觉运动功能恢复的远期随访研究

  

  • 出版日期:2025-08-01 发布日期:2025-09-08

Long-term follow-up study on the sensory and motor function recovery of foot after repair of forefoot plantar wounds with retrograde medial plantar flap 

  • Online:2025-08-01 Published:2025-09-08

摘要:

目的 探讨应用逆行足底内侧皮瓣修复前足底创面后的感觉和运动功能恢复情况。方法 回顾性分析我科2016年2月至2023年8月共15例应用逆行足底内侧皮瓣修复足前端创面的患者临床资料。前足底创面的致伤原因包括肿瘤切除(9 例,其中黑色素瘤 8 例、硬纤维瘤 1 例)、电击伤(3 例)、撕脱伤(1 例)和糖尿病足(2 例)。切取皮瓣范围5 cm×5 cm~6 cm×8 cm。术后随访13~103个月,评估供区和受区外观、皮瓣感觉、足趾感觉与运动功能。结果 15例皮瓣术后血运正常。两例皮瓣出现术后静脉淤血,给予针刺放血、肝素盐水冲洗等处理后缓解,未影响皮瓣成活。术后第1、3个月常规来院复查,15例皮瓣外观良好,无臃肿,质地柔软,温觉、痛觉与二点辨别觉丧失。2024年9月开展远期随访,失访4例,其中死亡1例,失联3例,余11例患者地面行走无困难,步态正常;皮瓣触觉、痛觉、二点分辨觉部分恢复;同侧足趾主动屈曲、主动背伸功能均存在;足趾肌力分级(徒手肌力检查,MMT)均大于等于4级。结论 逆行足底内侧皮瓣修复前足底中小面积创面能恢复前足外观、承重和运动功能及部分感觉功能,效果良好。

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Abstract:

 Objective To evaluate the recovery of sensory and motor function after repair of forefoot plantar wounds with
retrograde medial plantar flap. Methods The clinical data of 15 patients with forefoot plantar wounds that were repaired by retrograde medial plantar flap from February 2016 to August 2023 were retrospectively reviewed. The causes of the wounds included electric injury (3 cases), avulsion injury (1 case), diabetes mellitus (2 cases), and tumor resection (9 cases,including 8 melanomas and 1 desmoid). The size of harvested flaps ranged from 5 cm×5 cm to 6 cm×8 cm. Patients were followed up for 13-103 months to evaluate the flap sensation, sensory and motor function of the foot and toe, and appearance of donor and recipient site. Results The blood supply of all flaps was good after operation. Postoperative venous congestion occurred in 2 cases, which was relieved by needle puncture for bloodletting and heparin saline flushing. One-month and three-month postoperative follow-up showed that all 15 flaps presented soft texture and good appearance without bloating.
However, the sensation of pain, temperature and two-point discrimination were lost. In the long-term follow-up initiated in September 2024, four cases were lost to follow-up, three of them were unavailable and one died. The remaining 11 patients could walk on the ground in normal gait without difficulty. Sensation of pain, temperature and touch were partially restored. Futhermore, active flexion and extention of the toes on the affected side were present, and toe muscle strength (Manual Muscle Testing, MMT) was graded≥4. Conclusion The retrograde medial plantar flap is effective in repairing small to  medium-size forefoot plantar wounds by achieving good appearance, restoring the sensory, motor and weight-bearing function partially to a reasonable extent.

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