Shah S, Sehmbi A S, Jeyaseelan L
Queen's Hospital, Barking Havering Redbridge NHS trust, London, United Kingdom.
Royal London Hospital, Barts Health NHS trust, London, United Kingdom.
JPRAS Open. 2022 Sep 2;34:60-63. doi: 10.1016/j.jpra.2022.08.005. eCollection 2022 Dec.
Rupture of the Achilles tendon typically occurs at the mid-substance, and less commonly at the distal insertion or proximal musculotendinous junction. We report the case of a 60-year-old multi-morbid patient presenting with an avulsion of the Achilles tendon from the gastrocnemius-soleus complex - a variant of injury previously unrecorded in the literature. Initial Orthoplastic management involved debridement and primary fixation of the avulsed tendon to the muscle with a concurrent lateral rotational flap. Flap failure and loss of tendon viability necessitated further debridement and eventual split-skin grafting (SSG). A residual dorsiflexion deformity will undoubtedly require further operative intervention. Here, we report the management of this unreported variant of Achilles tendon injury and discuss alternatives to our initial management that could have resulted in fewer procedures and improved long-term functional outcomes.
跟腱断裂通常发生在肌腱中部，较少发生在远端附着点或近端肌肉肌腱交界处。我们报告了一例60岁患有多种疾病的患者，其跟腱从腓肠肌-比目鱼肌复合体处撕脱，这种损伤变体在以往文献中未曾记录。最初的整形外科处理包括清创以及将撕脱的肌腱原位固定于肌肉，并同时采用外侧旋转皮瓣。皮瓣坏死和肌腱失活需要进一步清创，最终进行了分层皮片移植。残留的背屈畸形无疑需要进一步的手术干预。在此，我们报告了这种未报道过的跟腱损伤变体的处理情况，并讨论了一些替代我们最初处理方式的方法，这些方法可能会减少手术次数并改善长期功能预后。
