"Dismantle" the right foot "make up" the left foot! Doctor: "Stitch repair" for another 20 years of life

Wuhan Evening News (reporter Wang Chunlan correspondent Jiang Hongying Chen Shu) left foot accidentally injured, the soles of the feet, heel defects, need to do complex flap surgery for reconstruction. The skin in the part of the regular flap is too delicate and soft, and it is easy to wear out the heel when walking in the future. "At least let him walk normally for the next 20 years!" The doctor cleverly dismantled and repaired the "guy" to recreate the heel that was not afraid of wear.

Accidentally injured, the "guy" left foot was smashed

The "guy" in the doctor's mouth is 57 years old this year, and everyone calls him Lao Lin.

Lao Lin worked in Wuhan, and in early May this year, he accidentally injured his left foot by a cement slab on the construction site, and the entire foot was blurred with blood and flesh, the calcaneus was fractured, and the skin, tendons and blood vessels of the foot were seriously damaged. He was taken to the nearest hospital, where doctors debride the wound, replant the skin, and perform fracture surgery.

After the operation, he recuperated for nearly a month, and all the replanted skin died. In June, Lao Lin did debridement surgery again, changing the dressing many times, but the heel, sole and side of the foot, as well as the side and dorsal side of the foot, there are a wide range of skin soft tissue defects, has been oozing blood, the wound also has a large number of necrotic tissue, the entire foot blood and flesh blurred, completely unable to get off the ground, can only lie on the bed all day. Such a severe defect requires major surgery to re-transplant free flaps (i.e., skin with nerve and vascular tissue) and reconstruct a new heel and sole. The local hospital did not have this technique, so it was recommended that he be transferred to a large hospital with microsurgery technology.

In early July, the family sent Lao Lin to the Shouyi Branch of Wuhan Third Hospital for treatment.

"You're still young, and we must have thought of saving our left foot and walking for at least 20 years." Ji Wei, a plastic surgeon who received the treatment, comforted Lao Lin: "In 2020, the average life expectancy in Wuhan has exceeded 80 years old, and you are not yet 60 years old, don't give up hope!" ”

Where to "mend" the heel? The doctor was embarrassed

Two-thirds of Lao Lin's left foot is blurred with flesh and blood, with skin soft tissue defects about 21 cm long and 15 cm wide, defects throughout the heel, and a large range of necrotic tissue residues on the wound.

As is customary, skin grafting is required for large wounds, often taking flaps with blood vessels from the thighs. But what old Lin needs to repair is the heel and soles of his feet. Among them, the heel is a weight-bearing area, although the old Lin is thin, but the weight is also more than 120 pounds, the skin of the thighs is more delicate, the heel after reconstruction is not wear-resistant enough, in the future, if you walk on the ground, the heel part is easy to be worn, resulting in skin necrosis, infection, heel osteomyelitis and other consequences, and may require amputation when serious.

If he wants To let Lao Lin walk with confidence in the next 20 years, he must try to find a wear-resistant flap on his own body, and he must also be able to repair the huge defect. Ji Wei pondered several times and finally thought of a good way to "dismantle" his right foot and "make up" his left foot.

It turns out that although the skin of the foot plate heart is not as wear-resistant as the heel, it is thicker than other parts of the body, and it is the ideal solution to "move" the skin of the foot center of The old Lin's right foot to the left foot to make the heel.

"Seam repair" to recreate the wear-resistant heel

On July 17, Lao Lin was pushed into the operating room.

According to the preoperative design, Ji Wei first carried out a thorough debridement of the wound of his left foot, and then removed a 10 cm long and 4.5 cm wide flap from the center of the right foot plate, together with blood vessels and nerves, to the heel of the left foot; then removed the 22 cm long and 7 cm wide flap from the front and outer side of his right thigh to repair the center of the left foot; and finally removed a part of the skin from the right thigh to "repair" the wound of the right foot plate and the instep of the left foot.

Schematic diagram of a suture made by a doctor. Photo courtesy of the interviewee Dr. Ji Wei

"The surgery needs to be very delicate, and the whole surgical process must be fully concentrated." Ji Wei told the Yangtze River Daily reporter that when designing surgery, it is necessary to carry out fine splicing design according to the size and shape of the wound, just like tailoring, not more and no less; when cutting the flap, it is necessary to separate many blood vessels and nerves, just like the removal of mines, can not damage the slightest; when the flap is installed to a new position, it must also be strictly in accordance with the preoperative design of the plan, precise suture, to ensure that the blood vessels fit in place, "any vascular embolism, will lead to heel, sole flap all necrosis." ”

Ji Wei recalled that the operation was done for 8 hours, and finally, after loosening the blood vessel clamp of The old Lin's left calf, he saw that the bright red blood was injected from the calf blood vessel into the blood vessel of the heel flap, and then injected into the blood vessel of the sole flap of the foot, and the newly transplanted two flaps were ruddy in color, the blood ran well, and the doctors sighed: the operation was successful!

After the operation, Lao Lin recovered smoothly. Not long ago, he sent a WeChat message to Ji Wei: you can walk on the ground by yourself, and you have gone out to visit relatives normally on National Day.

【Editor: Hu Hui】