Primary in situ replantation plus stage-II transfer of free medial plantar flap in treatment of whole foot skin degloving injury
10.3760/cma.j.cn441206-20240914-00209
- VernacularTitle:一期原位回植二期游离足底内侧皮瓣在全足皮肤脱套伤中的应用
- Author:
Xingzhou ZHANG
1
;
Yajun XU
;
Jiandong ZHOU
;
Xingfei ZHANG
;
Yuxuan ZHANG
Author Information
1. 常州市武进中医医院（南京中医药大学武进附属医院）骨科，常州 213100
- Publication Type:Journal Article
- Keywords:
Whole foot skin degloving injury;
Medial plantar flap;
Replantation;
Microsurgical techniques
- From:
Chinese Journal of Microsurgery
2025;48(3):303-308
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore a staged repair procedure for whole foot skin degloving injury and evaluate the clinical outcome.Methods:From August 2020 to March 2023, a retrospective analysis was conducted on 20 patients, 12 males and 8 females, with who had whole foot skin avulsion injuries and were treated at the Department of Foot and Ankle Surgery, Ninth People's Hospital of Wuxi City. Nine injuries of foot skin avulsion were on the left feet and 11 on the right. All patients underwent a primary in situ replantation of the avulsed skin, and a stage-II surgery based on clinical manifestations and combined together with plantar pressure analysis in order to design a contralateral free medial plantar flap for reconstruction of the weight-bearing area of the affected foot. Eleven patients received the reconstructive surgery for forefoot weight-bearing area, and 9 had the reconstructive surgery for the heel weight-bearing area. The flap sizes ranged from 4 cm×4 cm to 13 cm×8 cm. All flap donor sites were closed with full-thickness skin grafts from ipsilateral thigh. Scheduled postoperative follow-ups at outpatient clinic were conducted to observe the flap survival, appearance and texture of the foot skin. American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot functional scores and the British Medical Research Council (BMRC) sensory function scale for flap sensation evaluation were used for assessment of the surgical outcomes, as well as the patient satisfaction. Pre- and postoperative plantar pressure analyses were performed to compare the weight-bearing area, load ratio and average plantar pressure. Statistical analysis was conducted using One-way ANOVA and Chi-square tests. P<0.05 was considered statistically significant. Results:The postoperative follow-up lasted for 10 to 24 months, with an average of 12.1 months. All 20 flaps survived. The flap swelling, appearance and wear resistance were good with AOFAS scores at 70 - 88 points. The sensation recovery reached S 2 to S 3. Patient satisfaction was excellent in 19 patients and good in 1 patient. The preoperative weight-bearing area was measured at 84 cm 2 to 140 cm 2, and 93 cm 2 to 145 cm 2 after surgery. The preoperative load ratio was 25% to 40%, and 30% to 43% after surgery. The preoperative plantar pressure was 185 grams/cm 2 to 356 grams/cm 2, and that was 205 grams/cm 2 to 381 grams/cm 2 after surgery. The postoperative weight bearing area, load ratio and mean plantar pressure of the patients were found all superior to those before surgery, with statistically significant differences ( P<0.05). Conclusion:In primary surgery, the avulsed skin is in situ replanted meanwhile have the original plantar skin preserved as much as possible. In the stage-II surgery, a contralateral medial free plantar flap is precisely designed to reconstruct the foot weight-bearing area, according to the healing of the in situ replanted skin and the wear resistance of the skin in weight-bearing area, and an analysis of plantar pressure should be performed. This is a reliable surgical procedure in the treatment of a degloving injury of whole foot.
