带髂胫束的薄层游离股前外侧皮瓣修复足跟部软组织缺损并重建跟腱

Repair of soft tissue defect around posterior calcaneal region combined with Achilles tendon defect by the thin-layer free anterolateral thigh flap with iliotibial band

目的 探讨带髂胫束的薄层游离股前外侧皮瓣修复足跟部软组织缺损并重建跟腱的临床疗效.方法 2017年1月-2017年12月,采用带髂胫束的薄层游离股前外侧皮瓣修复足跟部软组织并跟腱缺损共11例.其中5例合并胫骨或腓骨骨折,3例合并踝关节骨折,1例合并跟骨骨折.软组织缺损范围6.5 cm×10.0 cm^8.0 cm×13.0 cm,跟腱缺损长度5.5~11.5 cm.创面一期予清创加VSD处理,6d后采用带髂胫束的薄层游离股前外侧皮瓣同时重建跟腱及足跟后区软组织,术后制定合理的康复训练.结果 11例皮瓣均成活,供区Ⅰ期愈合.患者通过门诊复查、电话、微信获得随访,时间8~20个月,平均15.74个月.2例皮瓣外形稍臃肿,1年后予皮瓣修薄手术,其余皮瓣外形良好,厚度适中.末次随访时,皮瓣质地柔软,有弹性.皮瓣感觉恢复可,足跟后区两点辨别觉为3.0~5.0 mm,平均4.11 mm.Thompson征阴性,双和(或)单足提踵试验阴性,无跟腱再断裂、跟区皮肤破溃等并发症发生.患肢踝关节背伸活动范围(23.11±1.17)°,跖屈活动范围为(43.67±1.06)°,健侧踝关节背伸活动范围(23.79±1.03)°,跖屈活动范围为(44.03±0.94)°,内侧关节活动度差异无统计学意义(P>0.05).术后随访按Thermann功能评定系统进行评估,评估结果为优8例,良2例,可1例.结论 运用带髂胫束的薄层游离股前外侧皮瓣修复足跟部软组织并跟腱缺损是一种可靠、有效的方法,能较好的恢复足踝部的外形及功能.

Objective To investigate the clinical effect of thin-layer free anterolateral thigh flap with iliotibial tract for reconstruction of heel soft tissue and Achilles tendon defect. Methods From January, 2017 to December, 2017, 11 cases of heel soft tissue and Achilles tendon defect were repaired by thin-layer free anterolateral thigh flap with iliotibial tract. There were 5 cases with tibia/fibula fracture, 3 cases with ankle fracture and 1 case with calcaneal fracture. The area of soft tissue defect was 6.5 cm×10.0 cm-8.0 cm×13.0 cm, and the length of Achilles tendon defect was 5.5-11.5 cm. All wounds were treated with debridement and negative pressure sealing drainage technique at first stage. After 6 days, the soft tissue defect around posterior calcaneal region combined with Achilles tendon defect were repaired by the thin-layer free anterolateral thigh flap with iliotibial tract. Reasonable rehabilitation training was established after operation. Results The flaps survived in 11 cases and the donor region healed in one stage. The patients were followed-up for 8 to 20(mean, 15.74) months by outpatient review, calling or WeChat. Slightly bloated in appearance in 2 cases, and were thinned by orthopedic operation 1 year later. The other flaps were well shaped and moderately thick. At the last follow-up, the flaps were soft in texture and elastic. The sensory recovery of the flap was good, and the two-point discriminant perception in the posterior region of the heel was 3.0-5.0(mean, 4.11) mm. Thompson’s sign was negative, double or one-foot heel lift test was negative, and there was no recurrence of Achilles tendon rupture or skin ulceration in the heel region. The range of motion(ROM) of affected side was (23.11±1.17)°of extension and (43.67±1.06)° of flexion, and the ROM of normal side was (23.79±1.03)°of extension and (44.03±0.94)°of flexion. There was no statistical difference between them(P>0.05). Postoperative follow-up was conducted according to the Thermann’s function evaluation system, the evaluated result was excellent in 8 cases, good in 2 cases, and receivability in 1 case. Conclusion It is a reliable and effective method to repair heel soft tissue and Achilles tendon defect by thin-layer free anterolateral thigh flap with iliotibial tract. And this method can better restore foot ankle shape and function.