梯形瘢痕跟腱瓣治疗瘢痕性足下垂

Treating Talipes Equines with Ladder Shaped Achilles Tendon Cicatricial Contracture Flap

目的:探索烧伤或外伤后瘢痕挛缩性足下垂的修复方法,改善手术治疗效果。方法:应用梯形瘢痕跟腱瓣治疗瘢痕性足下垂8例13侧,其中4例5侧足内翻严重者同时在内踝下加辅助切口矫正足内翻畸形。临床应用8例13侧,其中火焰烧伤4例,热水泥烧伤2例,化学烧伤1例,外伤1例。结果:8例13侧术后瘢痕跟腱瓣成活,未出现远端坏死;13侧踝关节均达到功能位复位,术后行走无跛行,但踝关节跖屈及背伸仍受限。结论:梯形瘢痕跟腱瓣技术操作简单,血供可靠、安全;小腿后侧瘢痕松解彻底,跟腱充分延长,便于足下垂畸形矫正,是矫治瘢痕挛缩性足下垂可选择的方法。

Objective： To investigate restorative procedure and surgical treatment effects of talipes equines owing to Achilles tendon cicatricial contracture after bum and trauma. Methods： 13 sides of 8 patients with cicatricial footdrop, including 4 flame burn, 2 hot cement bum, 1 chemical bum, 1 external injury, were treated by ladder shaped achillies tendon cicatricial contracture flap. incisal opening under medial mallcolus were synchronously performed on 4 cases with severe pes varus for correcting the strephenopodia. Results： All composite flaps were survival, no necrosis occurred in distal end of flaps. All 13 ankle joint obtained functional reposition. No limping after operation was observed, but the plant flex and lateralextension of ankle joint were restricted. Conclusion： Treating talipes equines with ladder shaped achilles tendon cicatricial contracture flap have advantages of simple operative technique, reliable and safe blood supply, perfect unclamp of scar in legs, sufficient extension of achillies tendon in favour of correction of footdrop. This method is alternative therapeutic for pedal apron deformity due to cicatricial contracture.