ANTEROLATERAL THIGH FASCIOCUTANEOUS FLAP FOR REPAIR OF OPEN Achilles TENDON DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Jiquan , GAN Ganda , LUO Ping , HUANG Yuhu.

Department of Trauma Microsurgery, No.181 Hospital of Chinese PLA, Focused Profession of Microsurgery of Guangzhou Military Region, Guilin Guangxi, 541002, P.R.China. Corresponding author: GAN Ganda, E-mail: ggda181@sina.com;

Corresponding author：

Keywords：

Open; Achilles tendon defect; Anterolateral thigh fasciocutaneous flap; Ankle joint; Wound repair

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Objective To explore the effectiveness of anterolateral thigh fasciocutaneous flap for repair of skin and soft tissue defect and simultaneous Achilles tendon reconstruction with modified 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 traffic 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 first intention was obtained. All patients were followed up 6-18 months (mean, 10 months). The flap was soft and flexible; the flap had slight encumbrance in 3 cases, and the others had good appearance. 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 affected side was (24.40 ± 2.17)° extension and (44.00 ± 1.94)° flexion, showing no significant 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 modified methods of ilio-tibial bundle suture is beneficial to function recovery of the ankle joint because early function exercises can be done.

Citation： TANG Jiquan,GAN Ganda,LUO Ping,HUANG Yuhu.. ANTEROLATERAL THIGH FASCIOCUTANEOUS FLAP FOR REPAIR OF OPEN Achilles TENDON DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1209-1312. doi: Copy

1.	李军, 徐永清, 汪新民, 等. 跟腱损伤修复术后局部软组织缺损的处理. 中国修复重建外科杂志, 2007, 21(4): 367-370.
2.	高建明, 徐达传, 王众, 等. 跟腱缺损的分类和手术治疗. 中华创伤骨科杂志, 2006, 8(2): 187-188.
3.	王晨霖, 于东升, 丛海波, 等. 带髂胫束的股前外侧皮瓣游离移植一期修复跟后区组织缺损. 中国修复重建外科杂志, 2006, 20(10): 1037-1039.
4.	李志安, 李振武, 姬林松. 带远端腓肠神经血管束腓肠肌肌皮瓣推进修复跟部皮肤及跟腱缺损. 中国修复重建外科杂志, 2010, 24(10): 1279-1280.
5.	余家阔, 曲绵域, 田得祥, 等. 陈旧性跟腱断裂的手术治疗和长期疗效观察. 中华骨科杂志, 1998, 18(7): 391-395.
6.	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.
7.	Moriyama M. Vascularized tendon grafting in the rabbit. J Reconstr Microsurg, 1992, 8(2): 83-91.
8.	刘东昕, 王虎, 李学东, 等. 阔筋膜移植治疗跟腱及皮肤同时缺损. 当代医学, 2011, 17(15): 33-34.
9.	赵磊, 王黎明, 蒋纯志, 等. 阔筋膜移植治疗陈旧性跟腱断裂. 实用骨科杂志, 2009, 15(2): 99-100.
10.	高建明, 徐达传, 李强, 等. 跟腱缺损显微外科修复的远期疗效. 中华显微外科杂志, 2006, 29(1): 6-9.
11.	林松庆, 徐皓. 陈旧性跟腱断裂合并皮肤缺损的修复. 中国修复重建外科杂志, 2003, 17(4): 328-330.
12.	唐继全, 甘干达, 陶智刚, 等. 应用股前外侧皮瓣修复手背软组织和指伸肌腱缺损. 创伤外科杂志, 2011, 13(4): 324-326.
13.	刘学胜, 曲连军, 刘雪涛, 等. 股前外侧皮瓣修复前臂皮肤缺损. 中国修复重建外科杂志, 2007, 21(12): 1391-1392.
14.	胡继超, 李钧, 陈波, 等. 双侧股前外侧皮瓣瓦合修复全足皮肤脱套伤. 中国修复重建外科杂志, 2006, 20(9): 952-953.
15.	蒲超, 朱红, 黄富国. 股前外侧皮瓣加髂骨植骨修复手背软组织及掌骨缺损二例. 中国修复重建外科杂志, 2008, 22(1): 25.
16.	李琰, 唐镇江. 中药熏洗加早期功能锻炼治疗屈指肌腱断裂术后42例临床观察. 中国民族民间医药杂志, 2010, 19(12): 139.
17.	王爱琴, 农春花, 利春叶, 等. 早期功能锻炼对屈指肌腱损伤修复后康复的影响. 全科护理, 2010, 8(1): 100-101.
18.	尹卫东, 王金波, 李成龙, 等. 带蒂筋膜脂肪瓣联合肌腱移植重建手背伸肌腱功能的临床研究. 中国美容医学, 2011, 20(3): 361-362.
19.	顾玉东, 王澍寰, 侍德. 手外科手术学. 上海: 上海医科大学出版社, 1999: 406.
20.	傅重洋, 曲巍, 程超, 等. 应用双津下缝合法修复跟腱断裂疗效分析. 中国修复重建外科杂志, 2011, 25(10): 1214-1217.

1. 李军, 徐永清, 汪新民, 等. 跟腱损伤修复术后局部软组织缺损的处理. 中国修复重建外科杂志, 2007, 21(4): 367-370.
2. 高建明, 徐达传, 王众, 等. 跟腱缺损的分类和手术治疗. 中华创伤骨科杂志, 2006, 8(2): 187-188.
3. 王晨霖, 于东升, 丛海波, 等. 带髂胫束的股前外侧皮瓣游离移植一期修复跟后区组织缺损. 中国修复重建外科杂志, 2006, 20(10): 1037-1039.
4. 李志安, 李振武, 姬林松. 带远端腓肠神经血管束腓肠肌肌皮瓣推进修复跟部皮肤及跟腱缺损. 中国修复重建外科杂志, 2010, 24(10): 1279-1280.
5. 余家阔, 曲绵域, 田得祥, 等. 陈旧性跟腱断裂的手术治疗和长期疗效观察. 中华骨科杂志, 1998, 18(7): 391-395.
6. 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.
7. Moriyama M. Vascularized tendon grafting in the rabbit. J Reconstr Microsurg, 1992, 8(2): 83-91.
8. 刘东昕, 王虎, 李学东, 等. 阔筋膜移植治疗跟腱及皮肤同时缺损. 当代医学, 2011, 17(15): 33-34.
9. 赵磊, 王黎明, 蒋纯志, 等. 阔筋膜移植治疗陈旧性跟腱断裂. 实用骨科杂志, 2009, 15(2): 99-100.
10. 高建明, 徐达传, 李强, 等. 跟腱缺损显微外科修复的远期疗效. 中华显微外科杂志, 2006, 29(1): 6-9.
11. 林松庆, 徐皓. 陈旧性跟腱断裂合并皮肤缺损的修复. 中国修复重建外科杂志, 2003, 17(4): 328-330.
12. 唐继全, 甘干达, 陶智刚, 等. 应用股前外侧皮瓣修复手背软组织和指伸肌腱缺损. 创伤外科杂志, 2011, 13(4): 324-326.
13. 刘学胜, 曲连军, 刘雪涛, 等. 股前外侧皮瓣修复前臂皮肤缺损. 中国修复重建外科杂志, 2007, 21(12): 1391-1392.
14. 胡继超, 李钧, 陈波, 等. 双侧股前外侧皮瓣瓦合修复全足皮肤脱套伤. 中国修复重建外科杂志, 2006, 20(9): 952-953.
15. 蒲超, 朱红, 黄富国. 股前外侧皮瓣加髂骨植骨修复手背软组织及掌骨缺损二例. 中国修复重建外科杂志, 2008, 22(1): 25.
16. 李琰, 唐镇江. 中药熏洗加早期功能锻炼治疗屈指肌腱断裂术后42例临床观察. 中国民族民间医药杂志, 2010, 19(12): 139.
17. 王爱琴, 农春花, 利春叶, 等. 早期功能锻炼对屈指肌腱损伤修复后康复的影响. 全科护理, 2010, 8(1): 100-101.
18. 尹卫东, 王金波, 李成龙, 等. 带蒂筋膜脂肪瓣联合肌腱移植重建手背伸肌腱功能的临床研究. 中国美容医学, 2011, 20(3): 361-362.
19. 顾玉东, 王澍寰, 侍德. 手外科手术学. 上海: 上海医科大学出版社, 1999: 406.
20. 傅重洋, 曲巍, 程超, 等. 应用双津下缝合法修复跟腱断裂疗效分析. 中国修复重建外科杂志, 2011, 25(10): 1214-1217.

Chinese Journal of Reparative and Reconstructive Surgery

ANTEROLATERAL THIGH FASCIOCUTANEOUS FLAP FOR REPAIR OF OPEN Achilles TENDON DEFECT

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