股前外侧筋膜皮瓣修复跟腱开放性缺损

ANTEROLATERAL THIGH FASCIOCUTANEOUS FLAP FOR REPAIR OF OPEN Achilles TENDON DEFECT

目的探讨股前外侧筋膜皮瓣修复跟腱部皮肤软组织缺损,同时采用改良方法缝合髂胫束重建跟腱的疗效。方法 2009年10月-2011年6月,收治10例跟腱开放性缺损患者。男7例,女3例;年龄5～60岁,中位年龄40岁。致伤原因:轮辐伤5例,重物砸伤3例,交通事故伤2例。伤后至入院时间2～24 h,平均8 h。创面范围11 cm×7 cm～18 cm×10 cm;跟腱缺损长度4～10 cm,平均7 cm。3例合并跟骨结节缺损。入院后行急诊清创、封闭式负压引流治疗5～7 d后,应用大小为11 cm×7 cm～20 cm×12 cm的股前外侧筋膜皮瓣移植修复皮肤软组织缺损,同时采用改良方法缝合髂胫束重建跟腱。皮瓣供区直接拉拢缝合或植皮修复。结果术后皮瓣及供区植皮均成活,创面均Ⅰ期愈合。患者均获随访,随访时间6～18个月,平均10个月。皮瓣质地柔软,有弹性;3例皮瓣外形稍臃肿,其余皮瓣外形良好。末次随访时,皮瓣两点辨别觉为2～4 cm,平均3 cm。患者行走正常,患侧踝关节背伸活动范围(24.40±2.17)°,与健侧(25.90±2.33)°比较,差异无统计学意义(t=1.591,P=0.129);跖屈活动范围为(44.00±1.94)°,与健侧(45.60±1.84)°比较,差异无统计学意义(t=1.735,P=0.100)。踝关节功能按Arner-Lindhoim评定法评定均为优。结论应用股前外侧筋膜皮瓣修复跟腱部皮肤软组织缺损,同时采用改良方法缝合髂胫束重建跟腱,术后能早期关节功能锻炼,有利于踝关节功能恢复。

Objective To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modi ed methods of ilio-tibial bundle suture.Methods Between October 2009 and June 2011,10 cases of Achilles tendon and soft tissue defects were treated.There were 7 males and 3 females,aged from 5 to 60 years（median,40 years）.Injury was caused by spoke in 5 cases,by heavy pound in 3 cases,and by tra c accident in 2 cases.The time between injury and admission was 2-24 hours（mean,8 hours）.The size of wound ranged from 11 cm × 7 cm to 18 cm × 10 cm;the length of Achilles tendon defect was 4-10 cm（mean,7 cm）.Three cases complicated by calcaneal tuberosity defect.After admission,emergency debridement and vacuum sealing drainage were performed for 5-7 days,anterolateral thigh fasciocutaneous flap transplantation of 11 cm × 7 cm to 20 cm × 12 cm was used to repair skin and soft tissue defects,and improved method of ilio-tibial bundle suture was used to reconstruct Achilles tendon.The flap donor site was closed directly or repaired with skin grafting to repair.Results All flaps and the graft skin at donor site survived,healing of wounds by rst intention was obtained.All patients were followed up 6-18 months（mean,10 months）.The flap was soft and exible;the flap had slight encumbrance in 3 cases,and the others had good flappearance.At last follow-up,two-point discrimination was 2-4 cm（mean,3 cm）.The patients were able to walk normally.The range of motion（ROM） of a ected side was（24.40 ± 2.17）° extension and（44.00 ± 1.94）° exion,showing no signi cant difference when compared with ROM of normal side [（25.90 ± 2.33）° and（45.60 ± 1.84）° ]（t=1.591,P=0.129;t=1.735,P=0.100）.According to Arner-Lindhoim assessment method for ankle joint function,all the patients obtained excellent results.Conclusion A combination of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defects and simultaneous Achilles tendon reconstruction with modi ed methods of ilio-tibial bundle suture is bene cial to function recovery of the ankle joint because early function exercises can be done.