Sabapathy S Raja, Venkataramani Hari, Latheef Latheesh, Bhardwaj Praveen
Department of Plastic Surgery, Hand, Reconstructive Microsurgery and Burns Ganga Hospital, Coimbatore, Tamil Nadu, India.
Indian J Plast Surg. 2013 Jan;46(1):121-3. doi: 10.4103/0970-0358.113729.
Loss of Achilles tendon combined with overlying soft tissue loss is a challenging problem. Multiple techniques like tendon graft with coverage by soft tissue flap or composite flaps have been used. All these options are technically demanding. Reports do exist whereby muscle flaps bridging the defect used as cover in course of time could transmit the tendon force across the defect. We are presenting a case where a free gracilis muscle flap used to cover the soft tissue defect at the Achilles tendon at 2 years follow up provided stable cover and produced active function of the Achilles tendon allowing the patient to stand tip toe. Mechanism of its action has been analysed by MRI and M-mode ultrasound. While in primary Achilles tendon injury reconstruction is still the recommended option, in complex situations mere filling of the gap with the flap without formal reconstruction of the tendon could give good functional outcome. This technique can be used in demanding situations.
跟腱缺失并伴有上方软组织缺失是一个具有挑战性的问题。已经采用了多种技术，如用软组织瓣或复合瓣覆盖的肌腱移植术。所有这些选择在技术上都要求很高。确实有报告称，随着时间的推移，桥接缺损的肌瓣用作覆盖物时可将肌腱力量传递过缺损处。我们在此呈现一个病例，在2年的随访中，一块游离股薄肌瓣用于覆盖跟腱处的软组织缺损，提供了稳定的覆盖并使跟腱产生了主动功能，让患者能够踮起脚尖站立。已通过MRI和M型超声分析了其作用机制。虽然在原发性跟腱损伤中，重建仍然是推荐的选择，但在复杂情况下，仅用瓣填充间隙而不进行正式的肌腱重建也可获得良好的功能结果。这种技术可用于要求较高的情况。
