Method for microsurgical repairing of tendo calcaneus and complex tissue defect / 中华显微外科杂志

ABSTRACT

Objectives To approach the method and clinical effect on tendo calcaneus and complex tissue defect with microsurgery repair.Methods Retrospective summary the methods of 356 cases with tendo calcaneus and complex tissueserious defect,which repaired by different microsurgery from June 1994 to March 201 1.Two type were divided on account of different degree of serious tendo calcaneus and complex tissue defect.Type Athe length of tendo calcaneus defect was less than 3 cm,and cutaneous deficiency is less than 3 cm × 20 cm.Direct suture (166 cases) or Abraham retrograde V-Y method (72 cases)was used to repair endo calcaneus defec,anfregional flap metastasis was used to repair cutaneous deficiency.Two hundred and thirtyeight cases were used by those methods,including of lateral heel flap repair(23 cases),medial plantar island flap(58 cases),instep island flap(40 cases),above medial malleolus flap(48 cases),above ateral malleolus flap (24 cases),sural nerve nutrient vessel flap (29 cases) gastrocnemius muscle flap (16 cases).Type Bthe length of tendo calcaneus defect was more than 3 cm,and cutaneous deficiency was more than 3 cm × 20 cm.Direct suture could not repair tendo calcaneus,the complex tissue flap free grafting was used to primary repair tendo calcaneus and complex tissue defect.One hundred and erghteen cases were used by those methods,including of tensor fasciae latae flap free grafting (52 cases),lateral above knee complex tissue flap free grafting (26 cases),latissimus dorsi muscle fascia flap free grafting (24 cases),rectus abdominis muscle front sheath flap free grafting (16 cases).Three hundred and fifty-six cases were repaired by these methods,including 238 cases of regional flap transfer 118 cases of tissue flap free grafting.Results In 238 cases of regional flap transfer,two hundred and twenty-six cases were successful,and 12 cases were partly success,which were wound healing by change dressings.In 118 cases of tissue flap free grafting,one hundred and nine cases were successful,and blood vesse articulo were happened to 8 casess,which were success by operations research,and 1 case was failure which had to use another tissue flap.Follow-up visit was dane from 1.0 year to 4.5 years after operation (average 3.2 years).Functional assessment according to the Thermann ralted the results as excellent in 240 csaes,good in 86 cases,common in 22 cases and worse in 8 cases.The fineness rate was 91.6％.Conclusion Microsurgical repair is a good method to tendo calcaneus and complex tissue defect,different method and strategy selected actively by tissue defect degree of tendo calcaneus and complex tissue can achieve satisfactory functional rehabilitation purpose.