Jepegnanam Thilak Samuel, Nithyananth Manasseh, Boopalan Palapattu R J V C, Cherian Vinoo Mathew, Titus Vijay Titus K
Department of Orthopaedics, St. Michael's Hospital, Toronto, Canada.
J Trauma. 2009 Mar;66(3):774-9. doi: 10.1097/TA.0b013e31817c96c7.
Open achilles tendon injuries, present a complex problem to the treating surgeon especially if associated with tendon and soft tissue loss. We present eight such patients treated with tendon repair/reconstruction and reverse flow sural artery flap for soft tissue cover.
Eight patients (age, 12-64 years) with a spectrum of open tendo-achilles injuries of acute and chronic (infected), including loss of tendon of up to 10 cm, tendon defects with no distal attachment and one with partial loss of the calcaneum were treated between November 2005 and July 2006. Two of them had significant medical comorbid factors. The skin defect measured after debridement ranged from 6 x 5 cm to 15 x 10 cm. The tendon injuries were sutured directly when possible or sutured to bone if avulsed from the calcaneum. They were otherwise reconstructed using the central part of the proximal segment. A reverse sural artery was used to provide soft tissue cover.
All flaps survived. All patients had a normal gait, were able to stand on tip toes, had active plantar flexion and had returned to their original occupation 4 months after reconstruction. They had full range of movement at the ankle. One diabetic patient had terminal necrosis of the flap that required a split skin graft. He developed a late infection which did not compromise the functional result.
In the management of complex tendo-achilles injuries with tendon and soft tissue loss, radical debridement, single stage tendon reconstruction, and reverse flow sural artery flap gives good functional outcome. This gives consistent results across a spectrum of open tendo-achilles injury.
开放性跟腱损伤给治疗外科医生带来了复杂的问题，尤其是当伴有肌腱和软组织缺损时。我们报告了8例此类患者，采用肌腱修复/重建及逆行腓肠动脉皮瓣覆盖软组织缺损。
2005年11月至2006年7月期间，共治疗8例患者（年龄12 - 64岁），他们患有各种急性和慢性（感染性）开放性跟腱损伤，包括肌腱缺损长达10厘米、肌腱无远端附着以及1例跟骨部分缺损。其中2例有明显的内科合并症。清创后皮肤缺损范围为6×5厘米至15×10厘米。肌腱损伤尽可能直接缝合，若从跟骨撕脱则缝合至骨面。否则，使用近端肌腱的中央部分进行重建。采用逆行腓肠动脉皮瓣提供软组织覆盖。
所有皮瓣均存活。所有患者步态正常，能够踮脚尖站立，有主动跖屈，重建后4个月恢复原工作。踝关节活动范围正常。1例糖尿病患者皮瓣末端坏死，需要进行植皮。他出现了晚期感染，但未影响功能结果。
在处理伴有肌腱和软组织缺损的复杂跟腱损伤时，彻底清创、一期肌腱重建及逆行腓肠动脉皮瓣可取得良好的功能结果。对于各种开放性跟腱损伤均能获得一致的效果。
