Repair of Achilles tendon exposure after operation of Achilles tendon rupture with retrograde sural neurovascular flap
10.3760/cma.j.cn114453-20200319-00169
- VernacularTitle:逆行腓肠神经营养血管皮瓣修复跟腱断裂术后跟腱外露
- Author:
Meng LIU
1
;
Fen SHI
;
Weiqiang LIANG
;
Jian ZHANG
;
Zheng SU
;
Jinming ZHANG
Author Information
1. 中山大学孙逸仙纪念医院整形外科，广州 510120
- Keywords:
Sural nerve;
Small saphenous vein;
Surgical flap;
Skin soft tissue defect;
Achilles tendon rupture
- From:
Chinese Journal of Plastic Surgery
2021;37(9):1026-1030
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore and summarize the feasibility and effect of repairing Achilles tendon exposure after repair of Achilles tendon rupture with retrograde sural neurovascular flap.Methods:The clinical data of patients with Achilles tendon exposure after repair of Achilles tendon rupture admitted to the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2016 to February 2019 were analyzed retrospectively. Under epidural anesthesia, the necrotic skin and soft tissue were removed entirely, and only the liquefied and necrotic surface of the Achilles tendon was removed. The previous surgical suture of the Achilles tendon was retained. After debridement, the wound surface was covered with a retrograde sural nerve flap. The blood supply and shape of the flap, foot sensation, and ankle function were observed after the operation.Results:The present study included seven patients (four males and three females, aged from 24 to 69 years old, with an average of 45.7 years old). The size of the skin and soft tissue defect at the exposed Achilles tendon was about 2.0 cm × 5.0 cm-5.0 cm × 7.0 cm, and the area of the flap was about 4.0 cm × 7.0 cm-6.5 cm × 9.0 cm. The wounds in the flap donor site of seven patients in this group were closed directly, while one patient whose blood supply of about distal 1 cm of the flap was unsatisfactory ten days after the operation. The patient received a dressing change for 21 days and the wound healed with scar. The other flaps transferred from other patients had a good blood supply, and all wounds in the flap donor site and the defect site healed well. All patients were followed up for 10 to 14 months. The color and texture of the flap were good without obvious bloating. The scar in the operation area was mild, and the heel movement was good. Mild numbness was still felt in the lateral part of the foot in four patients, but no paresthesia was noticed in other patients. The Kofoed ankle score was 78-97, with an average score of 88.3. There were six excellent cases and one good case.Conclusions:The sural neurovascular flap is adjacent to the defect area of Achilles tendon exposure. Although the open repair of Achilles tendon rupture has a certain influence on the skin soft tissue and blood circulation around the Achilles tendon area, it can still form a retrograde sural neurovascular flap with a slightly higher pedicle to repair the Achilles tendon exposure. The donor site can be closed directly with minor trauma. The technique is simple and effective as well.
