Bekeny Jenna C, Zolper Elizabeth G, Fan Kenneth L, Evans Karen K
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Plast Reconstr Surg Glob Open. 2020 Jul 14;8(7):e2959. doi: 10.1097/GOX.0000000000002959. eCollection 2020 Jul.
Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot become impaired, disrupting patient's gait. Reported techniques for repair fall into nonoperative (ankle-foot orthosis) or operative (primary closure, tendon transfer, free gracilis) modalities, depending on patient factors, mechanism of injury, and extent of defect. In this report, we outline a novel method of tendon repair and soft tissue coverage for a large defect.
We present a unique case of traumatic TAT rupture with a failed primary closure yielding a large (>15 cm) defect. The patient presented with a defect spanning the entire anterior compartment of the leg, limiting options for coverage and functional restoration.
The patient's large, chronic defect was successfully repaired via a composite cutaneous anterolateral thigh and a rolled fascia lata free flap. The patient had robust return to function and is able to dorsiflex and invert the foot and ambulate.
The use of this donor site offers a novel, advantageous option for TAT repair. It should be considered for patients with large defects that make other repair methods unfeasible.
胫前肌腱（TAT）断裂是一种罕见现象，由于病例报告稀少，治疗选择有限。如果胫前肌没有正确固定，足部的背屈和内翻就会受损，从而破坏患者的步态。根据患者因素、损伤机制和缺损程度，报道的修复技术分为非手术（踝足矫形器）或手术（一期缝合、肌腱转移、游离股薄肌）方式。在本报告中，我们概述了一种针对大缺损的肌腱修复和软组织覆盖的新方法。
我们报告了一例独特的创伤性TAT断裂病例，一期缝合失败导致大（>15 cm）缺损。患者出现跨越小腿整个前侧间隙的缺损，限制了覆盖和功能恢复的选择。
通过复合股前外侧皮瓣和卷状阔筋膜张肌游离皮瓣成功修复了患者的大的慢性缺损。患者功能强劲恢复，能够背屈和内翻足部并行走。
使用该供区为TAT修复提供了一种新的、有利的选择。对于因缺损大而使其他修复方法不可行的患者应考虑采用。
