Linz and Innsbruck, Austria; and Stuttgart, Germany From the Section of Plastic and Reconstructive Surgery, Linz General Hospital; Department of Plastic and Reconstructive Surgery, Marienhospital Stuttgart; and Department of Plastic and Reconstructive Surgery, Innsbruck Medical University.
Plast Reconstr Surg. 2012 Apr;129(4):910-919. doi: 10.1097/PRS.0b013e31824422da.
The Achilles tendon area is a delicate one, and therefore numerous publications describe methods of reconstruction with flaps. In the event of simultaneous tendon loss, suitable methods for tendon reconstruction have to be considered. The authors describe their experience with gracilis muscle flap reconstruction in this difficult area.
From March of 2003 until March of 2010, the authors performed a series of 20 patients receiving gracilis flaps for defects in the Achilles region alone or in combination with concomitant tendon loss. The authors retrospectively analyzed the origin and size of the defect, microsurgical success, and early and late complications needing operative treatment, as well as the aesthetic and functional outcome.
A total of 21 free gracilis muscle flaps were performed in 20 patients. The authors had one complete flap loss that was treated with a second gracilis flap. Follow-up ranged from 3 to 60 months (mean, 12.9 months). In four patients, simultaneous reconstruction of the Achilles tendon was carried out. Early postoperative complications included four hematomas (one at the donor site), two infections, and one skin graft loss, whereas late complications consisted of osteomyelitis and superficial ulceration in two patients, as well as rerupture of the Achilles tendon in one patient. Furthermore, the authors encountered one case of hypertrophic scarring and chronic fistulation at the donor site. Apart from that, functional and aesthetic outcome was judged to be good to excellent by the patients.
In the authors' opinion, the free gracilis muscle flap provides the surgeon with an exceptional tool for reconstruction in the critical Achilles region. It is appropriate for small and large defects, filling dead space under the tendon and becoming thin within several months. The ability for simultaneous tendon reconstruction due to available tendon graft material is a further strong advantage.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
跟腱区域比较脆弱，因此有大量文献描述了使用皮瓣进行重建的方法。在跟腱同时缺失的情况下，必须考虑合适的跟腱重建方法。作者在这一困难区域描述了使用股薄肌皮瓣重建的经验。
从 2003 年 3 月至 2010 年 3 月，作者对 20 例单独或合并跟腱同时缺失的患者进行了股薄肌皮瓣重建。作者回顾性分析了缺损的起源和大小、显微外科成功情况以及需要手术治疗的早期和晚期并发症，以及美学和功能结果。
20 例患者共进行了 21 例游离股薄肌皮瓣。作者有一例完全皮瓣失活，用第二块股薄肌皮瓣进行了治疗。随访时间为 3 至 60 个月（平均 12.9 个月）。在 4 例患者中，同时进行了跟腱重建。术后早期并发症包括 4 例血肿（1 例发生在供区）、2 例感染和 1 例皮片丢失，晚期并发症包括 2 例骨髓炎和浅表溃疡以及 1 例跟腱再断裂。此外，作者还遇到了 1 例供区肥厚性瘢痕和慢性窦道形成。除此之外，患者认为功能和美学结果是好到极好的。
作者认为，游离股薄肌皮瓣为外科医生在关键的跟腱区域提供了一种极好的重建工具。它适用于小和大的缺损，能够填充腱下的死腔，并在几个月内变薄。由于有可用的肌腱移植物，能够同时进行肌腱重建是另一个强有力的优势。
临床问题/证据水平：治疗性，IV 级。
