Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Peng ¹ , LIU Xiaochun ² , MOU Yong ² , HUANG Yongjun ² , SUN Dawei ² ,  HUANG Dong ²

1. University of South China, Hengyang Hunan, 421000, P.R.China;
2. Department of Orthopaedics, Guangdong Second People’s Hospital, Guangzhou Guangdong, 510220, P.R.China;

Corresponding author：

HUANG Dong, Email: 18898322176@163.com

Keywords：

Achilles tendon defect; skin defect; anterolateral femoral flap; fascia lata grafting

DOI：

10.7507/1002-1892.202007020

Video：

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Objective To investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects.Methods The clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side.Results Eighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° (t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° (t=0.444, P=0.660).Conclusion The application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.

Citation： ZHAO Peng, LIU Xiaochun, MOU Yong, HUANG Yongjun, SUN Dawei, HUANG Dong. Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1585-1589. doi: 10.7507/1002-1892.202007020 Copy

1.	赵天云, 王栓科, 刘新成, 等. 带肌蒂比目鱼肌肌腱瓣延长修复跟腱缺损的疗效分析. 中华显微外科杂志, 2009, 32(3): 240-241.
2.	杨运发, 张光明, 徐中和, 等. 应用足背外侧皮神经营养血管皮瓣修复跟腱外露创面. 中华显微外科杂志, 2010, 33(1): 58-59.
3.	郭翱, 郑良军, 李俊, 等. 应用吻合血管的游离肌腱瓣修复陈旧性跟腱缺损. 中华显微外科杂志, 2011, 34(5): 422-423.
4.	李扬, 郑世军, 李琛琦, 等. 胫后动脉双穿支蒂 V-Y 推进皮瓣修复跟腱区小面积软组织缺损. 中华显微外科杂志, 2018, 41(5): 421-423.
5.	丁治红, 李有斌, 张咸中, 等. 腓动脉穿支筋膜蒂皮瓣联合跟腱止点重建修复儿童足跟部严重轮辐伤. 实用手外科杂志, 2019, 33(3): 275-278.
6.	McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg (Am), 1997, 79(12): 1799-1808.
7.	王波, 李军. 改良经皮微创修复术治疗急性闭合性跟腱断裂的临床疗效研究. 创伤外科杂志, 2019, 21(7): 492-496.
8.	刘文科, 聂茂, 王卓群, 等. 陈旧性跟腱断裂的治疗现状与展望. 中国矫形外科杂志, 2019, 27(18): 1687-1691.
9.	陈雪松, 陈建明, 肖茂明, 等. 腓动脉主穿支蒂腓肠神经营养血管皮瓣修复跟腱区创面. 中华整形外科杂志, 2012, 28(1): 22-25.
10.	寿建国, 付彪, 徐晓汉, 等. 修薄股前外侧皮瓣联合阔筋膜修复手和足部复合组织缺损. 中华显微外科杂志, 2013, 36(3): 273-275.
11.	Taylor GI, Townsend P. Composite free flap and tendon transfer: an anatomical study and a clinical technique. Br J Plast Surg, 1979, 32(3): 170-183.
12.	唐举玉, 李康华. 股前外侧皮瓣的临床研究进展. 中国临床解剖学杂志, 2009, 27(1): 111-113.
13.	张治家, 刘洁, 郭芳芳, 等. 股前外侧皮瓣带血管化的阔筋膜在跟腱及软组织缺损中的应用. 中华临床医师杂志 (电子版), 2019, 13(12): 918-921.
14.	陈长顺, 胡祥, 郑前进, 等. 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. 中华显微外科杂志, 2019, 42(1): 37-41.
15.	李红, 陈世新, 唐茂林, 等. 穿支皮瓣 choke vessels 新生的研究进展. 中国临床解剖学杂志, 2016, 34(6): 711-712, 715.
16.	唐茂林, 刘元波. 穿支皮瓣的解剖学研究进展. 中华整形外科杂志, 2018, 34(9): 785-790.
17.	巨积辉, 周荣, 刘跃飞, 等. 超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果. 中华烧伤杂志, 2019, 35(7): 495-500.
18.	金光哲, 巨积辉, 熊胜, 等. 单叶或双叶带阔筋膜的股前外侧皮瓣在手足背皮肤肌腱缺损中的应用. 中华手外科杂志, 2019, 35(4): 241-243.
19.	朱青安, 李汉云, 钟世镇, 等. 跟腱自体修复材料的生物力学评价. 中国临床解剖学杂志, 1991, 9(4): 238-240.
20.	张功林, 葛宝丰, 王世勇. 吻合血管的阔筋膜瓣移植修复跟腱缺损. 中华显微外科杂志, 1999, 22(2): 146-147.

1. 赵天云, 王栓科, 刘新成, 等. 带肌蒂比目鱼肌肌腱瓣延长修复跟腱缺损的疗效分析. 中华显微外科杂志, 2009, 32(3): 240-241.
2. 杨运发, 张光明, 徐中和, 等. 应用足背外侧皮神经营养血管皮瓣修复跟腱外露创面. 中华显微外科杂志, 2010, 33(1): 58-59.
3. 郭翱, 郑良军, 李俊, 等. 应用吻合血管的游离肌腱瓣修复陈旧性跟腱缺损. 中华显微外科杂志, 2011, 34(5): 422-423.
4. 李扬, 郑世军, 李琛琦, 等. 胫后动脉双穿支蒂 V-Y 推进皮瓣修复跟腱区小面积软组织缺损. 中华显微外科杂志, 2018, 41(5): 421-423.
5. 丁治红, 李有斌, 张咸中, 等. 腓动脉穿支筋膜蒂皮瓣联合跟腱止点重建修复儿童足跟部严重轮辐伤. 实用手外科杂志, 2019, 33(3): 275-278.
6. McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg (Am), 1997, 79(12): 1799-1808.
7. 王波, 李军. 改良经皮微创修复术治疗急性闭合性跟腱断裂的临床疗效研究. 创伤外科杂志, 2019, 21(7): 492-496.
8. 刘文科, 聂茂, 王卓群, 等. 陈旧性跟腱断裂的治疗现状与展望. 中国矫形外科杂志, 2019, 27(18): 1687-1691.
9. 陈雪松, 陈建明, 肖茂明, 等. 腓动脉主穿支蒂腓肠神经营养血管皮瓣修复跟腱区创面. 中华整形外科杂志, 2012, 28(1): 22-25.
10. 寿建国, 付彪, 徐晓汉, 等. 修薄股前外侧皮瓣联合阔筋膜修复手和足部复合组织缺损. 中华显微外科杂志, 2013, 36(3): 273-275.
11. Taylor GI, Townsend P. Composite free flap and tendon transfer: an anatomical study and a clinical technique. Br J Plast Surg, 1979, 32(3): 170-183.
12. 唐举玉, 李康华. 股前外侧皮瓣的临床研究进展. 中国临床解剖学杂志, 2009, 27(1): 111-113.
13. 张治家, 刘洁, 郭芳芳, 等. 股前外侧皮瓣带血管化的阔筋膜在跟腱及软组织缺损中的应用. 中华临床医师杂志 (电子版), 2019, 13(12): 918-921.
14. 陈长顺, 胡祥, 郑前进, 等. 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. 中华显微外科杂志, 2019, 42(1): 37-41.
15. 李红, 陈世新, 唐茂林, 等. 穿支皮瓣 choke vessels 新生的研究进展. 中国临床解剖学杂志, 2016, 34(6): 711-712, 715.
16. 唐茂林, 刘元波. 穿支皮瓣的解剖学研究进展. 中华整形外科杂志, 2018, 34(9): 785-790.
17. 巨积辉, 周荣, 刘跃飞, 等. 超长股外侧区内增压型穿支皮瓣修复足踝部创面的临床效果. 中华烧伤杂志, 2019, 35(7): 495-500.
18. 金光哲, 巨积辉, 熊胜, 等. 单叶或双叶带阔筋膜的股前外侧皮瓣在手足背皮肤肌腱缺损中的应用. 中华手外科杂志, 2019, 35(4): 241-243.
19. 朱青安, 李汉云, 钟世镇, 等. 跟腱自体修复材料的生物力学评价. 中国临床解剖学杂志, 1991, 9(4): 238-240.
20. 张功林, 葛宝丰, 王世勇. 吻合血管的阔筋膜瓣移植修复跟腱缺损. 中华显微外科杂志, 1999, 22(2): 146-147.

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Chinese Journal of Reparative and Reconstructive Surgery

Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects

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