腓肠神经营养血管皮瓣结合腓肠肌腱瓣翻转治疗跟腱断裂并皮肤缺损

Application of sural neurocutaneous vascular flap and reversed gastrocnemius tendon flap for the treatment of Achilles tendon rupture and skin defects

目的探讨腓肠神经营养血管皮瓣结合腓肠肌腱瓣翻转治疗跟腱断裂并皮肤缺损的临床效果。方法 2009年3月至2012年1月云浮广业硫铁矿集团有限公司医院收治7例跟腱开放性断裂并皮肤缺损,皮肤缺损范围最大7.2 cm×4.0 cm,最小2.0 cm×1.8 cm,平均缺损面积5.1 cm×3.0 cm。6例跟腱缺损≤6 cm,1例跟腱缺损6.5 cm,平均缺损长度3.6 cm。采用腓肠肌腱瓣翻转修补跟腱断裂,同时用腓肠神经营养血管皮瓣覆盖跟腱部皮肤缺损。结果术后皮瓣全部成活。1例出现皮瓣远端皮缘表皮坏死,经换药后伤口愈合。7例患者获得5～34个月随访,平均随访时间18个月。Arner-Lindholm评分优4例、良2例、差1例。随访期间皮瓣外观及功能均满意,供区愈合良好。无跟腱再次断裂发生。结论腓肠神经营养血管皮瓣结合腓肠肌腱瓣翻转是治疗跟腱断裂并皮肤缺损可供选择的有效方法之一。

Objective To explore clinical effect of sural neurocutaneous vascular flap and reversed gastrocnemius tendon flap for the treatment of Achilles tendon rupture and skin defects. Methods From March 2009 to January 2012, 7 cases of open rupture of Achilles tendon and skin defects were treated in Yunfu Guangye pyrite Group Co Ltd hospital. The area of skin defect was 2.0 cm × 1.8 cm to 7.2 cm × 4.0 cm with the average of 5.1 cm × 3.0 cm, the average length of skin defect was 3.6 cm including equal or less than 6 cm in 6 cases and 6.5 cm in 1 case. Reversed gastrocnemius flap was used to repair Achilles tendon rupture, and at the same time, overlying skin defect was reconstructed by sural neurocutaneous vascular flap. Results All flaps survived after the surgery. Epidermal necrosis at the distant border of the flap occurred in 1 case, and then was cured by dressing change. Seven patients were followed up from 5 to 34 months, with the average of 18 months. According to Arner-Lindholm score, there were excellent in 4 cases, good in 2 cases and poor in 1 case. The appearances and the functions of the flaps were satisfactory, and the healing effects of the donor site were good. No Achilles tendon rupture had happened again. Conclusion Application of sural neurocutaneous vascular flap and reversed gastrocnemius tendon flap is a effective method to be chosen for the treatment of Achilles tendon rupture and skin defects.