Babu V, Chittaranjan S, Abraham G, Korula R J
Department of Orthopaedics, Christian Medical College Hospital, Vellore, India.
Plast Reconstr Surg. 1994 Apr;93(5):1090-4. doi: 10.1097/00006534-199404001-00033.
Open ruptures of the Achilles tendon with loss of the tendon and the overlying skin are very difficult to treat. They pose the problems of (1) combating infection, (2) providing soft-tissue cover, and (3) bridging the gap in the tendon. They are generally managed as multi-staged procedures. Once the infection is brought under control with debridement and antibiotics, skin cover is provided by local transposition flaps, distant pedicle flaps, or free-tissue transfer with microvascular anastomoses. The tendon itself is repaired later by one of the conventional techniques. More recently, composite free-tissue transfers repairing the skin and tendon in a single stage have been reported. We describe a simple and very reliable procedure using a dorsalis pedis island flap which provides a vascularized, innervated musculotendinous unit (i.e., extensor digitorum brevis) to bridge the gap in the Achilles tendon and thin, mobile skin and fascia to close the defect in the skin. Two cases are presented, including the technical details, advantages, and limitations of this procedure.
跟腱开放性断裂且伴有肌腱及覆盖其上的皮肤缺损的情况极难治疗。它们带来了以下问题：（1）对抗感染；（2）提供软组织覆盖；（3）桥接肌腱缺损处。这类情况通常采用多阶段手术进行处理。一旦通过清创术和抗生素控制住感染，可通过局部转移皮瓣、远位带蒂皮瓣或微血管吻合的游离组织移植来提供皮肤覆盖。肌腱本身随后通过传统技术之一进行修复。最近，已有报道采用一期修复皮肤和肌腱的复合游离组织移植。我们描述一种使用足背岛状皮瓣的简单且非常可靠的手术方法，该皮瓣可提供一个带血管神经的肌肌腱单元（即趾短伸肌）来桥接跟腱缺损处，并提供薄而可活动的皮肤和筋膜来闭合皮肤缺损。本文介绍了两个病例，包括该手术方法的技术细节、优点及局限性。
