ObjectiveTo investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect. MethodsBetween February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation. Results The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05). ConclusionV-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.
Objective To investigate the clinical application of relaying lateral gastrocnemius artery perforator flap in reconstruction of the donor defect after distally sural flap transferring. Methods Between January 2014 and January 2016, 12 cases with foot and ankle defects were treated. There were 10 males and 2 females with an average age of 23.4 years (mean, 14-52 years). The injury was caused by motorcycle accident in 7 cases and traffic accident in 5 cases. The injury located at left limb in 7 cases and right limb in 5 cases. The size of soft tissue ranged from 10 cm×4 cm to 12 cm×6 cm. The disease duration was 2-84 hours (mean, 26.2 hours). The foot and ankle defects were reconstructed by distally sural flaps, then the flap donor sites were reconstructed with relaying lateral gastrocnemius artery perforator flap at the same stage. The size of distally sural flap ranged from 11 cm×5 cm to 13 cm×7 cm. The size of relaying flap ranged from 7 cm×4 cm to 10 cm×6 cm. Results All flaps survived uneventfully. All recipient sites and donor sites healed smoothly. No vascular crisis, wound dehiscence, or evident swelling occurred. All patients were followed up 6-14 months (mean, 12.4 months) with satisfied esthetic and functional results in recipient and donor sites. There were only linear scar on the donor sites. The color and contour was satisfying, the function of calf and foot were not affected. Conclusion The relaying lateral gastrocnemius artery perforator flap combined with distally sural flap is an idea choice to reconstruct foot and ankle defect, which can avoid donor site skin grafting, minimize donor site morbidity.
ObjectiveTo investigate the effectiveness of V-Y advanced medial gastrocnemius muscle flap to repair soft tissue defects in the middle and lower segments of the anterior tibia. MethodsBetween March 2008 and March 2014, 8 patients with skin and soft tissue defects of the anterior tibia were treated, including 6 males and 2 females with an average age of 36.2 years (range, 28-47 years). The soft tissue defects located at the left leg in 5 cases and at the right leg in 3 cases. The causes included traffic accident injury in 6 cases, and heavy pound injury in 2 cases. Three cases had simple soft tissue defects, and the disease course was 5 hours, 6 days, and 14 days, respectively. Five cases had soft tissue defects and fractures, including 1 case of Pilon fracture, and 4 cases of middle and distal tibial fracture; open reduction and internal fixation were performed in 3 cases, the implementation of external fixation in 2 cases; 1 case had chronic osteomyelitis at 11 months after operation, and 4 cases had skin necrosis and wound infection at 1 to 2 weeks after operation; the duration was 1-12 months (mean, 3.4 months). The skin and soft tissue defect area was 5.2 cm×2.5 cm to 13.0 cm×5.5 cm. Debridement was given, and vacuum sealing drainage was used in 6 cases, and then V-Y advancement of medial gastrocnemius muscle flap was used to cover the wound. Because of light wound contamination, the wound was repaired by the flap after emergency debridement in 1 case; 1 patient with osteomyelitis underwent flap repair at immediate after sensitive antibiotics use and debridement. The size of medial gastrocnemius muscle flaps ranged from 15 cm×6 cm to 26 cm×15 cm. The donor site was sutured in 3 cases or repaired with skin graft in 5 cases. ResultsOne case had tension blisters in the distal flap, which was cured after symptomatic treatment. The flap and skin graft survived, and primary healing was obtained in the other cases. Seven patients were followed up 6-18 months (mean, 9 months). The texture and appearance of the flaps were satisfactory. At 6 months after operation, two-point discrimination ranged from 12 to 18 mm (mean, 16 mm). The plantar flexion was weaker than that of normal side, but the patients could normally walk and had normal gait. ConclusionThe V-Y advancement of medial gastrocnemius muscle flap is recommendable to repair soft tissue defects in the middle and lower segments of the anterior tibia for the advantages of reliable blood supply, simple operation, high survival rate of the flap, and satisfactory appearance.
Objective To observe the mRNA and protein expression of wingless-type MMTV integration site family member 5a (Wnt5a), glycogen synthase kinase 3 (GSK3), and β-catenin, as well as the muscle fibers and adipose tissue presented in pathological staining in the gastrocnemius muscle of white rabbits with blunt gastrocnemius contusion injuries, and provide a basis for revealing the repair mechanism of the pressing and kneading method in treating skeletal muscle injury. Methods Forty-two healthy male and female New Zealand white rabbits were selected. They were randomly divided into blank group, model 3-day group, model 7-day group, model 14-day group, press-and-knead 3-day group, press-and-knead 7-day group, and press-and-knead 14-day group, by using a random number table method, with 6 rabbits in each group. Samples of the model groups and the press-and-knead groups were taken on the 4th, 8th and 15th days after operation. The mRNA and protein expression of Wnt5a, GSK3, and β-catenin were detected by quantitative polymerase chain reaction and Western blot; the muscle tissue myofibers and adipose tissue were observed by hematoxylin and eosin (HE) staining and oil red O staining. Results The HE staining results showed that significant fibrous tissue proliferation and inflammatory cell infiltration occurred in the model 7-day group; in the model 14-day group, some muscle fibers were degenerated, necrotic, and regenerated, accompanied by fibrous tissue proliferation, slight inflammatory cell infiltration, and slight calcification; in the press-and-knead groups, obvious muscle fiber degeneration, necrosis, and regeneration, and inflammatory cell infiltration were observed, accompanied by significant fibrous tissue proliferation. The oil red O staining results showed that adipocyte deposition was visible in the model groups, which was the heaviest in the model 7-day group; in the press-and-knead groups, muscle fibers and sequences were not significantly damaged, and a small amount of adipocyte infiltration was visible in the interstitial space. There were statistically significant differences in the mRNA expression and protein expression of Wnt5a, GSK3, and β-catenin in the gastrocnemius among groups (P<0.001). Conclusions The histopathological changes of gastrocnemius muscle injury recover gradually over time, and the pressing and kneading method stimulates the mRNA expression activities of Wnt5a, GSK3, and β-catenin, which may slow down the degradation of β-catenin protein by the scaffolding protein complex (of which GSK3 is an important component), so that the protein level of β-catenin is maintained in the stable range at all times. This leads to a reduction of fatty degeneration in the gastrocnemius muscle after the intervention of pressing and kneading method, and promotes the functional repair of the injured skeletal muscle.
ObjectiveTo investigate the effectiveness of all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement in the treatment of Haglund’s disease complicated with gastrocnemius aponeurosis contracture. MethodsA retrospective analysis was conducted on the clinical data of 50 patients with Haglund’s disease complicated by gastrocnemius aponeurosis contracture, who were admitted and met the selection criteria between April 2020 and March 2022. Based on the surgical approach, the patients were divided into an observation group (26 cases, 26 feet, undergoing all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement) and a control group (24 cases, 24 feet, undergoing open Achilles tendon insertion debridement only). There was no significant difference (P>0.05) in baseline data between the two groups, including gender, age, body mass index, affected side, preoperative Fowler-Philip angle (FPA), visual analogue scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, Victorian Institute of Sport Assessment-Achilles (VISA-A) score, and ankle dorsiflexion range of motion (ROM). Surgical duration, incision length, intraoperative blood loss, time to return to daily activities and sports, and incidence of complications were recorded and compared between the two groups. FPA was measured at 1 month after operation and the changes before and after operation were calculated. Functional recovery was evaluated by comparing VAS score, AOFAS ankle-hindfoot score, VISA-A score, and ankle dorsiflexion ROM before operation and at 1, 3, 12 months after operation. Results The observation group had a longer surgical duration but lower intraoperative blood loss and shorter incision length compared to the control group, with all differences being significant (P<0.05). One patient in the observation group experienced postoperative limb numbness, while 3 patients in the control group developed incision redness and swelling, all of which resolved after symptomatic treatment. The remaining patients showed good postoperative incision healing, with no complication such as infection or neurovascular injury occurring in any case. All patients were followed up 12-20 months, with an average of 18.3 months. The observation group had shorter recovery time for both daily activities and sports activities compared to the control group (P<0.05). There was no significant difference between the two groups in the preoperative to postoperative change in FPA (P>0.05). In both groups, the VAS scores, AOFAS ankle-hindfoot scores, VISA-A scores, and ankle dorsiflexion ROM showed significant improvement at each postoperative time point compared with preoperative values, furthermore, all these indicators continued to improve progressively over time postoperatively, with all differences being significant (P<0.05). At each postoperative time point, the AOFAS ankle-hindfoot scores, VISA-A scores, and ankle dorsiflexion ROM in the observation group were significantly better than those in the control group (P<0.05), with ankle dorsiflexion ROM showing particularly superior improvement. However, no significant difference was observed in VAS scores between the two groups (P>0.05). At 12 months postoperatively, according to the VISA-A scores, the observation group achieved excellent results in 20 cases and good in 6 cases, while the control group achieved excellent results in 10 cases and good in 14 cases. The excellent and good rates were 100% in both groups. ConclusionCompared with open Achilles tendon insertion debridement alone, the all-arthroscopic gastrocnemius aponeurosis release and Achilles tendon insertion debridement demonstrates superior efficacy in improving ankle ROM, promoting functional recovery of the foot, and minimizing surgical trauma for the treatment of Haglund’s disease complicated by gastrocnemius aponeurosis contracture.