股前外侧皮瓣联合阔筋膜移植修复大段跟腱及皮肤缺损  

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

作　　者：赵鹏 刘晓春[2] 牟勇[2] 黄永军[2] 孙大炜[2] 黄东[2] ZHAO Peng;LIU Xiaochun;MOU Yong;HUANG Yongjun;SUN Dawei;HUANG Dong(University of South China,Hengyang Hunan,421000,P.R.China;Department of Orthopaedics,Guangdong Second People's Hospital,Guangzhou Guangdong,510220,P.R.China)

机构地区：[1]南华大学,湖南衡阳421000 [2]广东省第二人民医院创伤骨科,广州510220

出　　处：《中国修复重建外科杂志》2020年第12期1585-1589,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨股前外侧皮瓣联合阔筋膜移植修复大段跟腱及皮肤缺损的临床疗效。方法回顾分析2018年1月—2019年1月应用股前外侧皮瓣联合阔筋膜移植修复的18例大段跟腱及皮肤缺损患者临床资料。男14例,女4例;年龄32~57岁,平均42.1岁。跟腱断裂术后感染9例,交通事故伤1例,足跟部外伤后皮肤、跟腱缺损合并感染8例。跟腱缺损长度为4~8 cm,平均5.6 cm;皮肤缺损范围为14 cm×3 cm^20 cm×5 cm。术后观察皮瓣成活情况,按McComis功能评定标准评价踝关节功能恢复,末次随访时测量患肢踝关节背伸、跖屈活动度,并与健侧比较。结果18例均获随访,随访时间8~24个月,平均16.7个月。术后皮瓣全部成活,皮瓣质地柔软、弹性良好;切口均Ⅰ期愈合。末次随访时按McComis功能评定标准评价踝关节功能,优15例、良2例、可1例,优良率94.4%。患足跟后区两点辨别觉为4~7 mm,平均5.32 mm。患足提踵试验阴性。患侧踝关节背伸活动度为(21.55±1.26)°,与健侧(25.23±1.45)°比较差异有统计学意义(t=8.128,P=0.000);患侧跖屈活动度为(44.17±1.52)°,与健侧(46.13±1.31)°比较差异无统计学意义(t=0.444,P=0.660)。结论应用股前外侧皮瓣联合阔筋膜移植修复大段跟腱及皮肤缺损可取得良好疗效。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 January2018 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 A

关 键 词：跟腱缺损 皮肤缺损 股前外侧皮瓣 阔筋膜移植 

分 类 号：R658.3[医药卫生—外科学]