ObjectiveTo investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect. MethodsBetween February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation. Results The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05). ConclusionV-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.
ObjectiveTo evaluate the effectiveness of free anterolateral thigh flap in repairing hand twist trauma combined with forearm main vascular injury.MethodsBetween February 2016 and March 2020, 14 patients with hand twist trauma combined with forearm main vascular injury were admitted. There were 10 males and 4 females. The mean age was 36.3 years (range, 22-53 years). There were 5 cases with left hand and 9 cases with right hand. The degloving injury of hand was rated as type ⅢA in 2 cases, type ⅢB in 9 cases, and type Ⅳ in 3 cases. The size of soft tissue defects range from 8.0 cm×4.5 cm to 13.5 cm×8.0 cm. Of all patients, 11 cases were ulnar artery injury and 3 cases were radial artery injury. Time from injury to operation was 2-16 hours (mean, 7.1 hours). The free anterolateral thigh flaps with the size of 10.0 cm×5.5 cm to 15.0 cm×9.5 cm were used to repair the soft tissue defects with the “T” shape anastomosis of blood vessel in 8 cases or direct anastomosis of blood vessel in 6 cases. The donor sites were directly sutured in 9 cases and repaired with free skin graft in 5 cases.ResultsAll patients were followed up 6-12 months (mean, 10.5 months). The vascular crisis occurred in 1 case and the flap survived with symptomatic treatment after operation. Other flaps survived and the wounds healed by first intention. All donor sites healed by first intention and the skin grafts survived. Three cases underwent the fat-free trimming at 4-5 months after operation. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the hand function was evaluated as excellent in 4 cases, good in 7 cases, and fair in 3 cases, with an excellent and good rate of 78.6% at last follow-up.ConclusionBecause the diameter of the descending branch of the lateral femoral circumflex artery is similar to that of the ulnar artery and radial artery, the use of free anterolateral thigh flap can not only repair the wound and obtain a good hand shape, but also repair blood vessels and promote recovery of hand function.