One-stage reconstruction of soft tissue and achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: Clinical experience and functional assessment
One-stage reconstruction of soft tissue and achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: Clinical experience and functional assessment
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DOI：
10.1097/01.sap.0000037270.95257.b9
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发表时间：
2003-02-01
影响因子：
1.5
通讯作者：
Jeng, SF
中科院分区：
文献类型：
--
作者：
Kuo, YR;Kuo, MH;Jeng, SF
跟腱与上覆软组织的联合缺失是重建的挑战。为了实现可接受的康复，这些患者需要皮肤覆盖，包括跟腱的功能性修复。本文介绍四位病人成功地治疗了大腿前外侧（ALT）复合皮瓣与血管化阔筋膜。皮瓣长10 ~ 16 cm，宽6 ~ 9 cm。所有皮瓣均包括带血管蒂的阔筋膜，将其卷起作为带血管蒂的肌腱移植物（范围8 x 6 cm至10 x 8 cm）用于重建跟腱缺损。皮瓣成功率100%。所有患者均能在无支撑的情况下行走和爬楼梯;然而，据报告，跑步时存在轻度困难。通过使用动力测力计比较重建侧与健康对侧肢体，研究受体踝关节和供体大腿发病率的功能结果。在术后2年对2例患者进行了该评估。在重建的踝关节，等速向心测量背屈和跖屈显示赤字的30%和40%，分别。游离ALT复合瓣切取后，股四头肌收缩力的功能评估显示10%至25%的缺陷。但是，日常行走没有困难。总之，带血管蒂阔筋膜的游离复合ALT皮瓣为复杂缺损的跟腱重建提供了另一种选择。
The combined loss of the Achilles tendon with overlying soft tissue is a reconstructive challenge. To achieve acceptable rehabilitation, such patients need skin coverage including functional repair of the Achilles tendon. This article presents four such patients who were treated successfully by means of an anterolateral thigh (ALT) composite flap with vascularized fascia lata. The size of the ALT flaps ranged from 10 to 16 cm in length and 6 to 9 cm in width. All flaps included vascularized fascia lata, which was rolled to serve as vascularized tendon graft (range 8 x 6 cm to 10 x 8 cm) for reconstruction of the Achilles tendon defect. Flap success rate was 100%. All patients could walk and climb stairs without support; however, mild difficulty when running was reported. Functional outcome of the recipient ankle and donor thigh morbidity were investigated by using a kinetic dynamometer comparing reconstructed sides with the healthy contralateral limbs. This assessment was performed in two patients at 2 years postoperatively. In the reconstructed ankles, isokinetic concentric measurements of dorsiflexion and plantar flexion showed a deficit of 30% and 40%, respectively. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed a 10% to 25% deficit. However, there were no difficulties in daily ambulating. In summary, the free composite ALT flap with vascularized fascia lata provides an alternative option for Achilles tendon reconstruction in complex defects.