Lin Chu-Zhao, Xia Xue, Wang Hu, Liu Dong-Xin
Shantou University Medical School Postgraduate Student, Shantou University Medical College Department of Orthopaedic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Medicine (Baltimore). 2018 Feb;97(6):e9834. doi: 10.1097/MD.0000000000009834.
Children with simultaneous injury to the Achilles tendon and heel skin remain a challenge for clinicians. The purpose of this study is to evaluate a combined surgical procedure involving use of the fascia lata to reconstruct the Achilles tendon, and the posterior tibial artery perforator flap to cover the accompanying heel skin injury.Between February 2010 and February 2013, 8 children (3 females and 5 males) between 3 and 12 years of age, with a median age of 7.5 years, were hospitalized in the First Affiliated Hospital of Shantou University Medical College. All injuries involved damage to an Achilles tendon and heel skin. In all patients, the fascia lata was transplanted to reconstruct the Achilles tendon and the posterior tibial artery perforator flap transplanted to cover the skin injury.Hospitalization was 11 to 15 days (mean 13.5 days). Local necrosis (15% of the area) occurred in 1 flap, but healed after changing dressing. All other flaps survived well. At follow-up after 1 to 2 years, all children had recovered good plantar-flexion and supported their weight while walking. Use of the Arner-Lindholm standard to rate clinical efficacy revealed that of the 8 cases, 6 cases showed excellent recovery and 2 were good, with 0 cases ranking moderate or poor. The excellent and good rate was 100%.Child patients with Achilles tendon injury accompanied by heel skin injury are still a challenge for clinicians. Use of the fascia lata, combined with a posterior tibial artery perforator flap, to reconstruct the Achilles tendon and heel skin for children is a feasible, safe, effective method, faster than other methods for recovery, and should be widely applied in the clinic.
跟腱和足跟皮肤同时受伤的儿童对临床医生来说仍是一项挑战。本研究的目的是评估一种联合手术方法，即使用阔筋膜重建跟腱，并采用胫后动脉穿支皮瓣覆盖伴随的足跟皮肤损伤。2010年2月至2013年2月，8名年龄在3至12岁之间（中位年龄7.5岁）的儿童（3名女性和5名男性）入住汕头大学医学院第一附属医院。所有损伤均涉及跟腱和足跟皮肤受损。所有患者均移植阔筋膜重建跟腱，并移植胫后动脉穿支皮瓣覆盖皮肤损伤。住院时间为11至15天（平均13.5天）。1块皮瓣出现局部坏死（面积的15%），但换药后愈合。所有其他皮瓣均存活良好。在1至2年的随访中，所有儿童均恢复了良好的跖屈功能，行走时能支撑体重。采用Arner-Lindholm标准评估临床疗效，结果显示8例中6例恢复极佳，2例良好，无中度或差的病例。优良率为100%。跟腱损伤伴有足跟皮肤损伤的儿童患者对临床医生来说仍然是一项挑战。使用阔筋膜联合胫后动脉穿支皮瓣为儿童重建跟腱和足跟皮肤是一种可行、安全、有效的方法，恢复速度比其他方法更快，应在临床上广泛应用。
