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

目的评定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的疗效。方法2000年1月~2005年1月,收治跟腱合并跟后区皮肤缺损11例。其中男7例,女4例,年龄6~45岁。6例为跟腱合并跟后区皮肤缺损,5例为跟腱、跟后区皮肤合并跟骨骨折或部分跟骨缺损。皮肤缺损范围6cm×5cm~14cm×8cm,跟腱缺损长度5~11cm。皮瓣切取范围11cm×6cm~17cm×11cm。髂胫束的切取长度7~13cm,宽度3~5cm。将髂胫束内外侧缘内翻缝合成腱状形成双层髂胫束重建跟腱。供区创面直接缝合5例,余6例行游离全厚皮片植皮。结果术后所有皮瓣均成活,伤口期愈合。获随访6个月~4年。根据尹庆水疗效评价标准优6例,良4例,可1例。Thompson试验和提踵试验均为阴性。无跟腱再断裂、跟区皮肤破溃等并发症发生,足跟部两点辨别觉6~8mm。结论带髂胫束的股前外侧皮瓣游离移植是一种有效且能一期修复跟腱合并跟后区皮肤缺损的手术方法。

PRIMARY REPAIR OF TISSUE DEFECTS OF ACHILLES TENDON AND SKIN BY FREE GRAFTING OF ANTEROLATERAL FEMORAL SKIN FLAP AND ILIOTIBIAL TRACT

OBJECTIVE: To observe the clinical outcome of primary repair of the tissue defects of the Achilles tendon and skin by thigh anterolateral free flap and free iliotibial tract. METHODS: From January 2000 to January 2005, the thigh anterolateral free flap and the iliotibial tract were used to primarily repair the defects of the Achilles tendon and skin in 11 patients (7 males and 4 females, aged 6-45 years). The defects of the skin and Achilles tendon were found in 6 patients, and the defects of the Achilles tendon and skin accompanied by the fracture of the calcaneus were found in 5 patients. The defect of the Achilles skin was 6 cm X 5 cm-14 cm X 8 cm in area. The defect of the Achilles tendon was 5-11 cm in length. The skin flap was 11 cm X 6 cm-17 cm X 11 cm in area. The iliotibial tract was 7-13 cm in length and 3-5 cm in width. The medial and lateral borders were sutured to from double layers for Achilles tendon reconstruction. The wound on the donor site could be sutured directly in 5 patients, and the others could be repaired with skin grafting. RESULTS: After operation, all the flaps survived and the wound healed by first intention. The follow-up of the 11 patients for 6 mouths-4 years (average, 30 months) revealed that according to Yin Qingshui's scale, the result was excellent in 6 patients, good in 4, and fair in 1. The excellent and good rate was 99%. The results showed a significant improvement in the "heel test" and the Thompson sign, and both were negative. No complications of ulceration on the heel and re-rupture of the Achilles tendon occurred. CONCLUSION: The primary repair of the tissue defects of the Achilles tendon and skin by free grafting of the anterolateral femoral skin flap and the iliotibial tract is an effective surgical method.