摘要目的 探索利用腓骨短肌腱联合腱鞘外筋膜瓣修复跟腱并皮肤缺损的临床疗效.方法 自2004年4月至2015年5月,应用腓骨短肌腱联合腱鞘外筋膜瓣修复跟腱并皮肤缺损5例.其中,跟腱缺损3.0～8.0 cm,皮肤缺损面积2.0 cm×3.0 cm～3.0 cm×5.0 cm.跟腱缺损采用腓骨短肌重建,同时应用腓骨肌腱鞘筋膜瓣覆盖腓骨短肌,然后在其上植皮.术后定期随访,采用美国足踝外科协会(AOFAS)踝-后足评分系统进行疗效评价.结果 5例手术均获得成功,植皮成活.全部病例得到随访,时间6个月～10年,平均5.2年.在末次随访时,所有病例创面愈合良好.患足没有内翻畸形,提踵有力,恢复到伤前运动水平.AOFAS踝-后足评分由术前的(50.44±12.05)分提高至末次随访的(90.02±6.55)分(P＜0.05).结论 利用腓骨短肌腱联合腱鞘外筋膜瓣修复跟腱并皮肤缺损,具有手术方法简单、安全可靠且疗效满意等优点,是修复跟腱并皮肤缺损的较好方法.

abstractsObjective To explore the efficacy of peroneus brevis tendon transfer and peroneal tendofascial flap for repairing achilles tendon and overlying skin defect.Methods From April,2004 to May,2015,5 cases of achilles tendon and overlying skin defect were treated with peroneus brevis tendon transfer and peroneal tendofascial flap.In these cases,the length of the achilles tendon defect was from 3.0 cm to 8.0 cm,and the size of skin defect ranged from 2.0 cm × 3.0 cm to 3.0 cm × 5.0 cm.Using peroneus brevis tendon to reconstruct achilles tendon defect,and covered with peroneal tendofascial flap,and then skin graft.One of them combined with the gastrocnemius tendon V-Y advancement to promote the reconstruction of achilles tendon longer defect.The patients were followed-up regularly,and evaluated by the American Society of Ankle Arrhythmia (AOFAS) ankle-hindfoot scoring system.ResultsAll operations were successful and the grafted skin survived.All cases were followed-up from 6 months to 10 years with an average of 5.2 years.At the time of last followed-up,all wounds healed well without re-infection and ulceration.Not foot varus deformity and the strongth was back to the level before the injury.AOFAS ankle-hindfoot score was increased from (50.44 ± 12.05)(preoperative) to (90.02 ± 6.55)(the last follow-up) (P＜0.05).Conclusion There were some advantages in the method of the treatment of achilles tendon and overlying skin defect by using peroneus brevis tendon transfer and peroneal tendofascial flap,such as easy to cut,small damage to the donor area,and no significant deformity to the receptor area,etc.It is a good way to repair achilles tendon and overlying skin defects.