Lykoudis Efstathios G, Dalianoudis Ioannis, Seretis Konstantinos, Lykoudis George E, Lykissas Marios G
Department of Plastic Surgery, Ioannina University Hospital, Ioannina, Greece.
Department of Orthopaedic Surgey, Ioannina University Hospital, Ioannina, Greece.
Microsurgery. 2018 Mar;38(3):318-323. doi: 10.1002/micr.30277. Epub 2017 Dec 3.
Reconstruction of complex soft tissue defects in the distal lower leg remains challenging, since anatomical constraints limit the local options available in this area. In this report, we present a case of single stage functional reconstruction of both peroneal tendons and overlying skin with an anterolateral thigh flap and vascularized fascia lata. A 55-year-old patient underwent wide excision of a synovial sarcoma in the distal lower leg, which resulted in a complex defect including the peroneus longus and brevis tendons (10 cm), and the overlying skin (14 × 8 cm). Functional reconstruction was achieved in a single stage with a composite anterolateral thigh flap with vascularized fascia lata of similar dimensions to those of the defect. The fascia lata component of the flap was longitudinally split in two segments. Each of them was rolled up, and that way, two separate vascularized neotendons were created. The neotendons bridged the gap of peroneal tendons, whereas the skin paddle of the flap provided stable soft tissue coverage to the reconstructed tendons. Flap pedicle was anastomosed to the anterior tibial vessels. Early and late postoperative periods were uneventful. Follow up at 1 year postoperatively showed excellent neotendon incorporation, as well as a very good functional and aesthetic outcome. The use of the method described may be a useful alternative in single stage functional reconstruction of composite defects comprising two or even more tendons and the overlying skin.
小腿远端复杂软组织缺损的重建仍然具有挑战性，因为解剖学限制使得该区域可用的局部修复选择有限。在本报告中，我们展示了一例使用股前外侧皮瓣和带血管的阔筋膜对腓骨肌腱及其上方皮肤进行一期功能重建的病例。一名55岁患者接受了小腿远端滑膜肉瘤的广泛切除，导致了一个复杂的缺损，包括腓骨长肌和短肌肌腱（10厘米）以及上方皮肤（14×8厘米）。使用与缺损尺寸相似的带血管阔筋膜的股前外侧复合皮瓣进行一期功能重建。皮瓣的阔筋膜部分纵向分成两段。将每段卷起，从而形成两条独立的带血管新肌腱。新肌腱桥接了腓骨肌腱的缺损间隙，而皮瓣的皮岛为重建的肌腱提供了稳定的软组织覆盖。皮瓣蒂与胫前血管吻合。术后早期和晚期均无并发症。术后1年随访显示新肌腱融合良好，功能和美学效果非常好。所描述方法的应用可能是对包含两条或更多肌腱及其上方皮肤的复合缺损进行一期功能重建的一种有用替代方法。
