| 王季 蔡锦方 李宗玉 曹学成 王建超 解琛.带腓肠腱膜的腓肠神经营养皮瓣修复KuwadeⅣ型跟腱缺损[J].,2016,16(31):6072-6075 |
| 带腓肠腱膜的腓肠神经营养皮瓣修复KuwadeⅣ型跟腱缺损 |
| Repair of Kuwade Type IV Achilles Tendon Defect with SuralNeurocutaneous Flap Combined Gastrocnemius Aponeurosis |
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| DOI： |
| 中文关键词: 跟腱 组织缺损 皮瓣 修复 |
| 英文关键词: Tendon Soft tissue defect Flap Achilles Repair |
| 基金项目: |
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| 中文摘要: |
| 目的：回顾性分析带腓肠肌腱膜的腓肠神经营养皮瓣修复KuwadeⅣ型跟腱缺损的临床病例，探讨其手术注意事项及治疗
经验。方法：总结2008 年5 月- 2013 年8 月收治的KuwadeⅣ型跟腱缺损19 例，应用带腓肠肌腱膜的腓肠神经营养皮瓣进行一
期修复。7 例为新鲜损伤，12例为陈旧性缺损。19 例跟腱缺损均伴有皮肤及软组织坏死，皮肤缺损范围为4.0 cm× 6.0 cm -6.0
cm× 12.0 cm，跟腱缺损长度为5-9 cm，术中皮瓣切取范围为6.0 cm× 5.5 cm-12.0 cm× 8.0cm，腓肠腱膜切取范围5.5 cm× 6.0
cm-10.0 cm× 6.0 cm；供区游离植皮修复。客观性评价指标包括关节跖屈、背伸动度及形态学，主观性评价采用AOFAS评分。结
果：术后17 例跟腱功能重建良好，2例感染控制不良，跟腱移植体部分坏死。皮瓣完全成活13 例，创面Ⅰ期愈合。2 例术后6 天皮
瓣远端表皮坏死，经换药后愈合。2 例术后10 天皮瓣远端部分坏死，经局部皮瓣移位修复愈合，2 例感染控制不良者，皮瓣未愈
合，移植跟腱部分坏死，经再次清创后，行阔筋膜条修复术，局部皮瓣移位修复。术后19例均获随访，随访时间6 ～ 24 个月，平均
18 个月。术后皮瓣略臃肿，但不影响穿鞋，行走功能恢复良好，术后1 年AOFAS 评分平均80.31 分。结论：带腓肠肌腱膜的腓肠神
经营养皮瓣用于治疗KuwadeⅣ型跟腱缺损，可以同时修复皮肤及跟腱缺损，是一种较为理想的一期修复方法。 |
| 英文摘要: |
| Objective:To retrospectively analyze the clinical experience of repairing Kuwade type IV Achilles tendon defect with
Sural neurocutaneous flap combined gastrocnemius aponeurosis and to explore the surgery matters needing attention and treatment experience.Methods:Between 2008 May and 2014 February, 19 cases of Kuwade type IV Achilles tendon defects were repaired with Sural
neurocutaneous flap combined gastrocnemius aponeurosis. 7 cases were fresh injury, 12 cases were old defects. 19 cases of Achilles tendon
defects were accompanied by skin and soft tissue necrosis. The size of the wounds ranged from4.0 cm× 6.0 cm to 6.0 cm× 12.0 cm.
The length of tendon defect ranged from5 cmto 9 cm. The size of the flaps ranged from6 cm× 5.5 cmto 12 cm × 8 cm. The size of gastrocnemius
aponeurosis ranged from5.5 cm × 6 cmto 10 cm × 6 cm. The donor sites were covered with intermediate split thickness skin
grafts. The objective evaluated indexes included range of plantar flexion and dorsal flexion and morphology. The subjective evaluation
was obtained by AOFAS scores.Results:17 cases reconstructive achilles tendon survived well. 2 cases experience recurrent infection and
partial necrosis of Achilles tendon transplantation. 13 flaps survived uneventfully, wounds healed by first intention. 2 cases with skin
necrosis of distal epidermis were healed by wound care. Operative revision was required for 2 cases with delayed-onset soft tissue infections
and 2 cases with donor site necrosis. Nineteen patients were followed up 6-24 months (mean, 18 months). The appearance was
slightly overstaffed, but wearing shoe function and gait were normal. The average score of AOFAS in 1 year was 80.31 points.Conclusion:For Kuwade type IV Achilles tendon defect, Sural neurocutaneous flap with gastrocnemius aponeurosis can repair skin and tendon
defects in one stage. It is a kind of ideal repair method. |
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