CHARACTERISTICS AND TREATMENT OF GRADE Ⅲ SPOKE HEEL INJURIES IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HEXiaoqing , ZHUYueliang ,  XUYongqing , WANGYi , MEILiangbin , LIYang

Institute of Trauma Orthopedic Surgery of Chinese PLA, Kunming General Hospital of Chengdu Military Region, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

XUYongqing, Email: xuyongqingkm@163.net

Keywords：

Heel; Spoke injury; Achilles tendon repair; Children

DOI：

10.7507/1002-1892.20140322

Video：

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Objective To evaluate the characteristics, treatment, and effectiveness of grade Ⅲ spoke heel injury in children. Methods Between January 2007 and June 2013, 31 children with grade Ⅲ spoke heel injuries were treated. There were 19 boys and 12 girls, aged from 3 to 12 years (mean, 5.2 years). The time from trauma to operation was 2 hours to 26 days (mean, 4.4 days). The soft tissue defects of the heels ranged from 3.5 cm×2.5 cm to 8.0 cm×4.5 cm, which all complicated with Achilles tendon and calcaneus tuberosity defects. In 16 cases of large Achilles tendon defects which can not be stretched straightly to calcaneus tuberosities, repair with sl iding gastrocnemius musculocutaneous flaps (16 cm×5 cm to 21 cm×10 cm ) and insertion reconstruction of the tendon were performed. In 15 cases of Achilles tendon defects which can be stretched straightly to calcaneus tuberosities, repair with reversed pedicled flap (4.0 cm×2.5 cm to 8.0 cm×4.5 cm) and insertion reconstruction of the tendon were given. Nerve anastomosis was not performed. The donor site was covered with spl it-thickness skin graft. Results All children were followed up 6 months to 4 years (mean, 13 months). The other flaps survived except 3 cases having partial necrosis. The color and appearance of the flaps were satisfactory, with no impact on wearing shoes and walking. The flaps recovered sensory function. As more follow-up time, the angle of dorsal flexion was gradually improved. Heel raising on one leg was restored. The bone amount of calcaneus tuberosity increased slowly based on X-ray films. Conclusion Grade Ⅲ spoke heel injury in children possesses pecul iar features, surgical methods should be based on defects of Achilles tendon and soft tissue. Dorsal flexion of the ankle is obviously l imited; as follow-up time goes on, the ankle function is progressively improved. However, long-term follow-up is needed.

Citation： HEXiaoqing, ZHUYueliang, XUYongqing, WANGYi, MEILiangbin, LIYang. CHARACTERISTICS AND TREATMENT OF GRADE Ⅲ SPOKE HEEL INJURIES IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1490-1493. doi: 10.7507/1002-1892.20140322 Copy

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2.	徐向陽, 周炎, 瞿新叢. 腓腸神經營養血管皮瓣逆行修復兒童跟腱部輪輻傷. 創傷外科雜志, 2013, 15(2):133-135.
3.	Zhu YL, Li J, Ma WQ, et al. Motorcycle spoke injuries of the heel. Injury, 2011, 42(4):356-361.
4.	徐永清, 楊軍, 朱躍良, 等. 雙蒂腓腸肌皮瓣修復跟腱及皮膚缺損的解剖學研究及臨床應用. 中華創傷骨科雜志, 2006, 8(12):1132-1134.
5.	楊太明, 孔祥如, 高先亭, 等. 推進腓腸肌皮瓣修復跟腱開放性缺損. 中國修復重建外科雜志, 2011, 25(12):1519-1520.
6.	姚俊娜, 趙祚塨, 杜志軍, 等. 脛后動脈穿支皮瓣在足跟部軟組織缺損修復中的應用. 中華顯微外科雜志, 2014, 37(2):176-178.
7.	李振, 李忠, 劉雪濤, 等. 脛后動脈內踝上穿支皮瓣修復跟腱部皮膚軟組織缺損. 中國骨與關節損傷雜志, 2013, 28(2):182-183.
8.	吳必華, 魏在榮, 唐修俊, 等. 脛后動脈穿支蒂混合供血皮瓣修復兒童小腿創面. 中華小兒外科雜志, 2013, 34(5):349-352.
9.	肖峰, 肖宏, 郭筱秋. 帶腓腸神經營養血管逆行島狀皮瓣修復足跟部皮膚軟組織缺損. 中國修復重建外科雜志, 2009, 23(2):253-254.
10.	賈曉川, 劉振武, 劉利, 等. 改良腓腸神經營養血管皮瓣修復足跟部缺損26例. 實用手外科雜志, 2014, 28(1):86-87.
11.	董忠根, 楊穎, 魏建偉, 等. 腓動脈穿支筋膜蒂腓腸筋膜皮瓣聯合腓骨短肌腱轉位同期修復跟腱并皮膚缺損. 中華創傷骨科雜志, 2013, 15(12):1093-1095.
12.	胡長青, 王順義, 馬戰備, 等. 兒童足跟部嚴重損傷的骨及軟組織修復. 中華小兒外科雜志, 2013, 34(5):366-368.
13.	俞光榮, 趙宏謀, 袁鋒, 等. 兒童跟骨關節內骨折的分型特征及手術治療. 中華骨科雜志, 2011, 31(12):1319-1324.
14.	Zhu YL, Xu YQ, Yang J, et al. One-stage reconstruction of Achilles tendon and skin defects by the sliding gastrocnemius musculocutaneous flap without anastomosis. J Trauma, 2009, 66(4):1129-1134.
15.	于鐵強, 左玉明, 王月光, 等. 封閉式負壓引流技術聯合腓腸神經營養血管皮瓣修復兒童足跟部軟組織缺損. 中國修復重建外科雜志, 2013, 27(5):637-638.
16.	Lynn T. Stahel i. 實用小兒骨科學. 潘少川, 主譯. 北京:人民衛生出版社, 2008:4-6.

1. ?朱躍良, 徐永清, 李軍, 等. 兒童足后跟輪輻傷的臨床治療. 中國修復重建外科雜志, 2009, 23(10):1180-1182.
2. 徐向陽, 周炎, 瞿新叢. 腓腸神經營養血管皮瓣逆行修復兒童跟腱部輪輻傷. 創傷外科雜志, 2013, 15(2):133-135.
3. Zhu YL, Li J, Ma WQ, et al. Motorcycle spoke injuries of the heel. Injury, 2011, 42(4):356-361.
4. 徐永清, 楊軍, 朱躍良, 等. 雙蒂腓腸肌皮瓣修復跟腱及皮膚缺損的解剖學研究及臨床應用. 中華創傷骨科雜志, 2006, 8(12):1132-1134.
5. 楊太明, 孔祥如, 高先亭, 等. 推進腓腸肌皮瓣修復跟腱開放性缺損. 中國修復重建外科雜志, 2011, 25(12):1519-1520.
6. 姚俊娜, 趙祚塨, 杜志軍, 等. 脛后動脈穿支皮瓣在足跟部軟組織缺損修復中的應用. 中華顯微外科雜志, 2014, 37(2):176-178.
7. 李振, 李忠, 劉雪濤, 等. 脛后動脈內踝上穿支皮瓣修復跟腱部皮膚軟組織缺損. 中國骨與關節損傷雜志, 2013, 28(2):182-183.
8. 吳必華, 魏在榮, 唐修俊, 等. 脛后動脈穿支蒂混合供血皮瓣修復兒童小腿創面. 中華小兒外科雜志, 2013, 34(5):349-352.
9. 肖峰, 肖宏, 郭筱秋. 帶腓腸神經營養血管逆行島狀皮瓣修復足跟部皮膚軟組織缺損. 中國修復重建外科雜志, 2009, 23(2):253-254.
10. 賈曉川, 劉振武, 劉利, 等. 改良腓腸神經營養血管皮瓣修復足跟部缺損26例. 實用手外科雜志, 2014, 28(1):86-87.
11. 董忠根, 楊穎, 魏建偉, 等. 腓動脈穿支筋膜蒂腓腸筋膜皮瓣聯合腓骨短肌腱轉位同期修復跟腱并皮膚缺損. 中華創傷骨科雜志, 2013, 15(12):1093-1095.
12. 胡長青, 王順義, 馬戰備, 等. 兒童足跟部嚴重損傷的骨及軟組織修復. 中華小兒外科雜志, 2013, 34(5):366-368.
13. 俞光榮, 趙宏謀, 袁鋒, 等. 兒童跟骨關節內骨折的分型特征及手術治療. 中華骨科雜志, 2011, 31(12):1319-1324.
14. Zhu YL, Xu YQ, Yang J, et al. One-stage reconstruction of Achilles tendon and skin defects by the sliding gastrocnemius musculocutaneous flap without anastomosis. J Trauma, 2009, 66(4):1129-1134.
15. 于鐵強, 左玉明, 王月光, 等. 封閉式負壓引流技術聯合腓腸神經營養血管皮瓣修復兒童足跟部軟組織缺損. 中國修復重建外科雜志, 2013, 27(5):637-638.
16. Lynn T. Stahel i. 實用小兒骨科學. 潘少川, 主譯. 北京:人民衛生出版社, 2008:4-6.

Chinese Journal of Reparative and Reconstructive Surgery

CHARACTERISTICS AND TREATMENT OF GRADE Ⅲ SPOKE HEEL INJURIES IN CHILDREN

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