ABSTRACT
Objective:To investigate the surgical method and clinical effect of free medial plantar flap (MPF) combined with anterolateral thigh flap (ALTF) in repair of large soft tissue defect in the weight bearing area of sole.Methods:From April, 2017 to August, 2019, 8 patients with large soft tissue defects in plantar weight bearing area were repaired by free MPF combined with ALTF. Four patients had the defects located in the hindfoot and the surrounding area, 3 in the forefoot and 1 in the whole foot. A tandem flap made of free MPF combined with ALTF was used to repair the heel in 5 patients and repair the plantar forefoot in 3 patients. The size of defects ranged from 15.0 cm×10.0 cm to 26.0 cm×22.0 cm. The size of the MPF ranged from 6.0 cm×5.0 cm to 8.0 cm×6.5 cm. The donor sites repaired with full thickness skin graft. The size of ALTF ranged from 15.0 cm×7.0 cm to 27.0 cm×11.0 cm. Two donor sites were sutured directly, and the other 6 were repaired by full-thickness abdominal skin graft. The patients entered follow-up at outpatient clinic and via WeChat for 9 to 18 months.Results:All the 8 tandem flaps and the donor grafts survived. Only 1 ALTF had a distal necrosis and healed after change of dressing. All the flaps had good elasticity and good texture. All the recipient area of MPF achieved sensation recovery of pain and touch. But the ALTF only partially recovered tactile sensation. The weight-bearing and walking function were good. At the last follow-up, all patients were evaluated by Maryland foot score, of which 4 patients were excellent, 3 were good, and 1 was fair.Conclusion:The free MPF combined with ALTF is one of the ideal methods for the repair of plantar soft tissue defect in the weight bearing area of sole. It can better restore the foot weight-bearing and walking function with good clinical effect.
ABSTRACT
Objective To investigate high-frequency ultrasonic characters and screening method of plantar metatarsal level in normal adults.Methods Plantar metatarsal level were examined with high frequency ultrasound in 40 normal adults.The base,body and head of the first to the fifth metatarsal were used as anatomical location markers.The ultrasonic characters and screening method were described and recorded.Results The plantar skin,plantar fat pad,plantar aponeurosis and deep muscular structures,including the flexor digitorum brevis,abductor hallucis,abductor digiti minimi,lumbricalis,felxor hallucis brevis,flexor digiti minimi brevis,abductor hallucis and plantar interossei were illuminated in detail with high-frequency ultrasound.Conclusion High frequency ultrasound can be used to depict anatomical structures of plantar metatarsal level.