Experiences of Using the Free Gracilis Muscle Flap and Split Thickness Skin Graft for One-stage Foot Reconstruction

使用自由股薄肌肌肉瓣及分層植皮在足部的重建

10.7096/TJTSPS.201003.0040

陳信翰(Hsin-Han Chen)；吳肇毅(Chao-I Wu)；周爾康(Erh-Kang Chou)；鄭旭棠(Hsu-Tang Cheng)；許永昌(Yung-Chang Hsu)；張家寧(Chia-Ning Chang)

gracilis muscle flap ； foot reconstruction ； trauma ； chronic ulcer ； diabetes mellitus ； free muscle flap

臺灣整形外科醫學會雜誌

19卷1期（2010 / 03 / 01）

40 - 46

英文

背景： 足部的重建對於整形外科是個挑戰，雖然已經有許多自由皮瓣被應用在足部的重建，但是哪一種自由皮瓣對於足部的重建最好最適合還是有許多爭議與討論。 目的及目標： 我們在這篇文章分享使用自由股薄肌肌肉瓣及分層植皮在足部的重建經驗。 材料及方法： 總共有九位病人因為足部軟組織缺損而接受自由股薄肌肌肉瓣及分層植皮重建，受傷原因分別為6位外傷，2位糖尿病足，一位慢性傷口。其中有四位病人合併有足部骨折，股薄肌肌肉瓣的面積大小從42到88平方公分不等（平均64.8平方公分），足部受傷的部位可以分為6位足背，2位腳踝，1位足底。 結果： 九位病人的肌肉瓣皆成功，但其中有一個肌肉瓣有發生靜脈阻塞接受血管重接手術，二個病人的補皮區有部分植皮缺損。有兩位病人因為所要修補的缺損呈分叉形式，所以將股薄肌肌肉瓣的遠端縱向切開分別填補分開的兩處缺損。有四位病人合併有開放性骨折，在接受骨折固定及肌肉辦重建後皆沒有骨髓炎的併發症產生，所有病人最後都能恢復行走，不需要輔具的幫助，在後續的追蹤並沒有產生足部潰瘍或是傷口疼痛的情形，取肌肉瓣處的傷口癒合皆良好，病人皆可以接受取肌肉瓣所留下的疤痕。在後續的追蹤肌肉瓣有萎縮的情形出現，所以病人皆沒有接受第二次肌肉瓣打薄手術。所有病人皆可以穿鞋，不需要訂做特製的鞋具。 結論： 對於中等大小的軟組織缺損的足部傷口，不管有合併或沒有合併足部骨折，自由股薄肌肌肉瓣是一個可以考慮的重建方法，此肌肉瓣提供一個穩定的傷口覆蓋，病人可以接受的外觀且不需要接受第二次肌肉瓣打薄手術就可以穿鞋。

Background: Soft tissue reconstruction of the foot is a challenge in plastic surgery. Although many different types of free flaps have been used for foot reconstruction, the choice of an ideal free tissue transfer in complex soft tissue defect reconstruction remains controversial. Aim and objectives: In this paper, we present our experiences of using free gracilis muscle flaps for one-stage foot reconstruction. Materials and Methods: Nine patients underwent reconstruction with the free gracilis muscle flap and split thickness skin graft for foot soft tissue defects. Etiologic factors included trauma (6 patients), diabetes mellitus (2 patients), and chronic ulcer (1 patient). Four patients had concomitant fractures. The size of the gracilis muscle flap ranged from 42 to 88 cm^2 (mean, 64.8 cm^2). The anatomic regions of reconstruction were grouped as dorsum (n=6), ankle (n=2), and plantar foot (n=1). Results: Successful reconstruction was accomplished in all patients. One patient developed venous thrombosis, and there was partial skin graft loss in 2 patients. Longitudinal split of the gracilis muscles was performed in 2 patients for separate wound coverage. The concomitant open fracture in 4 patients healed without osteomyelitis complications. All patients returned to normal ambulation without assistive devices. There were no reported ulcerations in flap regions, and the patients were free of foot pain during the follow-up period. Donor-site wound healing was uneventful, and scarring was unapparent. In all patients, the muscle flap had progressive shrinkage and atrophy, therefore, debulking surgery was not performed. No patient required use of special shoes. Conclusions: The application of the free gracilis muscle flap and split thickness skin graft is a good choice for medium-sized foot defects with or without underlying bone fracture. Free gracilis muscle flaps provide stable coverage and an acceptable appearance without the necessity of secondary debulking surgery during long-term follow-up.