Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Peng ¹ , LIU Xiaochun ² , MOU Yong ² , HUANG Yongjun ² , SUN Dawei ² ,  HUANG Dong ²

1. University of South China, Hengyang Hunan, 421000, P.R.China;
2. Department of Orthopaedics, Guangdong Second People’s Hospital, Guangzhou Guangdong, 510220, P.R.China;

Corresponding?author：

HUANG Dong, Email: 18898322176@163.com

Keywords：

Achilles tendon defect; skin defect; anterolateral femoral flap; fascia lata grafting

DOI：

10.7507/1002-1892.202007020

Video：

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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 January 2018 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 Achilles tendon and skin defects can achieve good effectiveness.

Citation： ZHAO Peng, LIU Xiaochun, MOU Yong, HUANG Yongjun, SUN Dawei, HUANG Dong. Anterolateral femoral flap combined with fascia lata grafting for repair large Achilles tendon and skin defects. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1585-1589. doi: 10.7507/1002-1892.202007020 Copy

1.	趙天云, 王栓科, 劉新成, 等. 帶肌蒂比目魚肌肌腱瓣延長修復跟腱缺損的療效分析. 中華顯微外科雜志, 2009, 32(3): 240-241.
2.	楊運發, 張光明, 徐中和, 等. 應用足背外側皮神經營養血管皮瓣修復跟腱外露創面. 中華顯微外科雜志, 2010, 33(1): 58-59.
3.	郭翱, 鄭良軍, 李俊, 等. 應用吻合血管的游離肌腱瓣修復陳舊性跟腱缺損. 中華顯微外科雜志, 2011, 34(5): 422-423.
4.	李揚, 鄭世軍, 李琛琦, 等. 脛后動脈雙穿支蒂 V-Y 推進皮瓣修復跟腱區小面積軟組織缺損. 中華顯微外科雜志, 2018, 41(5): 421-423.
5.	丁治紅, 李有斌, 張咸中, 等. 腓動脈穿支筋膜蒂皮瓣聯合跟腱止點重建修復兒童足跟部嚴重輪輻傷. 實用手外科雜志, 2019, 33(3): 275-278.
6.	McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg (Am), 1997, 79(12): 1799-1808.
7.	王波, 李軍. 改良經皮微創修復術治療急性閉合性跟腱斷裂的臨床療效研究. 創傷外科雜志, 2019, 21(7): 492-496.
8.	劉文科, 聶茂, 王卓群, 等. 陳舊性跟腱斷裂的治療現狀與展望. 中國矯形外科雜志, 2019, 27(18): 1687-1691.
9.	陳雪松, 陳建明, 肖茂明, 等. 腓動脈主穿支蒂腓腸神經營養血管皮瓣修復跟腱區創面. 中華整形外科雜志, 2012, 28(1): 22-25.
10.	壽建國, 付彪, 徐曉漢, 等. 修薄股前外側皮瓣聯合闊筋膜修復手和足部復合組織缺損. 中華顯微外科雜志, 2013, 36(3): 273-275.
11.	Taylor GI, Townsend P. Composite free flap and tendon transfer: an anatomical study and a clinical technique. Br J Plast Surg, 1979, 32(3): 170-183.
12.	唐舉玉, 李康華. 股前外側皮瓣的臨床研究進展. 中國臨床解剖學雜志, 2009, 27(1): 111-113.
13.	張治家, 劉潔, 郭芳芳, 等. 股前外側皮瓣帶血管化的闊筋膜在跟腱及軟組織缺損中的應用. 中華臨床醫師雜志 (電子版), 2019, 13(12): 918-921.
14.	陳長順, 胡祥, 鄭前進, 等. 帶髂脛束的薄層游離股前外側皮瓣修復足跟部軟組織缺損并重建跟腱. 中華顯微外科雜志, 2019, 42(1): 37-41.
15.	李紅, 陳世新, 唐茂林, 等. 穿支皮瓣 choke vessels 新生的研究進展. 中國臨床解剖學雜志, 2016, 34(6): 711-712, 715.
16.	唐茂林, 劉元波. 穿支皮瓣的解剖學研究進展. 中華整形外科雜志, 2018, 34(9): 785-790.
17.	巨積輝, 周榮, 劉躍飛, 等. 超長股外側區內增壓型穿支皮瓣修復足踝部創面的臨床效果. 中華燒傷雜志, 2019, 35(7): 495-500.
18.	金光哲, 巨積輝, 熊勝, 等. 單葉或雙葉帶闊筋膜的股前外側皮瓣在手足背皮膚肌腱缺損中的應用. 中華手外科雜志, 2019, 35(4): 241-243.
19.	朱青安, 李漢云, 鐘世鎮, 等. 跟腱自體修復材料的生物力學評價. 中國臨床解剖學雜志, 1991, 9(4): 238-240.
20.	張功林, 葛寶豐, 王世勇. 吻合血管的闊筋膜瓣移植修復跟腱缺損. 中華顯微外科雜志, 1999, 22(2): 146-147.

1. 趙天云, 王栓科, 劉新成, 等. 帶肌蒂比目魚肌肌腱瓣延長修復跟腱缺損的療效分析. 中華顯微外科雜志, 2009, 32(3): 240-241.
2. 楊運發, 張光明, 徐中和, 等. 應用足背外側皮神經營養血管皮瓣修復跟腱外露創面. 中華顯微外科雜志, 2010, 33(1): 58-59.
3. 郭翱, 鄭良軍, 李俊, 等. 應用吻合血管的游離肌腱瓣修復陳舊性跟腱缺損. 中華顯微外科雜志, 2011, 34(5): 422-423.
4. 李揚, 鄭世軍, 李琛琦, 等. 脛后動脈雙穿支蒂 V-Y 推進皮瓣修復跟腱區小面積軟組織缺損. 中華顯微外科雜志, 2018, 41(5): 421-423.
5. 丁治紅, 李有斌, 張咸中, 等. 腓動脈穿支筋膜蒂皮瓣聯合跟腱止點重建修復兒童足跟部嚴重輪輻傷. 實用手外科雜志, 2019, 33(3): 275-278.
6. McComis GP, Nawoczenski DA, DeHaven KE. Functional bracing for rupture of the Achilles tendon. Clinical results and analysis of ground-reaction forces and temporal data. J Bone Joint Surg (Am), 1997, 79(12): 1799-1808.
7. 王波, 李軍. 改良經皮微創修復術治療急性閉合性跟腱斷裂的臨床療效研究. 創傷外科雜志, 2019, 21(7): 492-496.
8. 劉文科, 聶茂, 王卓群, 等. 陳舊性跟腱斷裂的治療現狀與展望. 中國矯形外科雜志, 2019, 27(18): 1687-1691.
9. 陳雪松, 陳建明, 肖茂明, 等. 腓動脈主穿支蒂腓腸神經營養血管皮瓣修復跟腱區創面. 中華整形外科雜志, 2012, 28(1): 22-25.
10. 壽建國, 付彪, 徐曉漢, 等. 修薄股前外側皮瓣聯合闊筋膜修復手和足部復合組織缺損. 中華顯微外科雜志, 2013, 36(3): 273-275.
11. Taylor GI, Townsend P. Composite free flap and tendon transfer: an anatomical study and a clinical technique. Br J Plast Surg, 1979, 32(3): 170-183.
12. 唐舉玉, 李康華. 股前外側皮瓣的臨床研究進展. 中國臨床解剖學雜志, 2009, 27(1): 111-113.
13. 張治家, 劉潔, 郭芳芳, 等. 股前外側皮瓣帶血管化的闊筋膜在跟腱及軟組織缺損中的應用. 中華臨床醫師雜志 (電子版), 2019, 13(12): 918-921.
14. 陳長順, 胡祥, 鄭前進, 等. 帶髂脛束的薄層游離股前外側皮瓣修復足跟部軟組織缺損并重建跟腱. 中華顯微外科雜志, 2019, 42(1): 37-41.
15. 李紅, 陳世新, 唐茂林, 等. 穿支皮瓣 choke vessels 新生的研究進展. 中國臨床解剖學雜志, 2016, 34(6): 711-712, 715.
16. 唐茂林, 劉元波. 穿支皮瓣的解剖學研究進展. 中華整形外科雜志, 2018, 34(9): 785-790.
17. 巨積輝, 周榮, 劉躍飛, 等. 超長股外側區內增壓型穿支皮瓣修復足踝部創面的臨床效果. 中華燒傷雜志, 2019, 35(7): 495-500.
18. 金光哲, 巨積輝, 熊勝, 等. 單葉或雙葉帶闊筋膜的股前外側皮瓣在手足背皮膚肌腱缺損中的應用. 中華手外科雜志, 2019, 35(4): 241-243.
19. 朱青安, 李漢云, 鐘世鎮, 等. 跟腱自體修復材料的生物力學評價. 中國臨床解剖學雜志, 1991, 9(4): 238-240.
20. 張功林, 葛寶豐, 王世勇. 吻合血管的闊筋膜瓣移植修復跟腱缺損. 中華顯微外科雜志, 1999, 22(2): 146-147.

Chinese Journal of Reparative and Reconstructive Surgery

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

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