摘要目的:探讨一期削薄的游离改良的带血管化阔筋膜（VFL）的股前外侧皮瓣（ALTF）修复跟腱合并软组织缺损的临床疗效。方法:回顾性分析2021年6月至2024年5月,广州和平骨科医院骨科收治的10例游离改良的带VFL的ALTF治疗跟腱合并软组织缺损的患者。患者男8例,女2例,年龄16~72岁。跟腱周围软组织缺损面积3.0 cm×11.0 cm~6.0 cm×34.0 cm；跟腱缺损长度4.0~7.0 cm；游离皮瓣面积4.0 cm×12.0 cm~7.0 cm×35.0 cm。5例供区直接缝合关闭,余5例缝线拉拢创面后VSD敷料覆盖,二期直接缝合关闭创面或缝合后植皮关闭创面。术后通过门诊、电话或微信随访,随访内容包括皮瓣术后早期和晚期并发症、供区和皮瓣的愈合情况。结果:本组10例患者均获得随访,随访时间1~3年。术后早期无并发症；晚期有1例受区肥厚性瘢痕,保守治疗。供区伤口愈合良好,仅有线形及植皮瘢痕,局部无压痛。所有游离皮瓣均I期成活；跟腱重建后效果根据Amer-Lindholm标准,优6例,良4例；患侧踝关节背伸角度10°~15°（健侧背伸角度25°）,跖屈角度20°~45°（健侧跖屈角度45°）；所有患者均可以提踵；日常活动能力:5例患者可以正常步行,5例可以慢跑；温哥华瘢痕量表（VSS）评估皮瓣外观为3~6分；美国足踝矫形学会踝-后足评分（AOFAS-AH）为87~96分；跟腱完全断裂评分（ATRS）85~95分；皮瓣修复处皮肤感觉均较正常迟钝。结论:游离改良的带VFL的ALTF适用于修复跟腱合并周围软组织缺损,其对血管变异敏感性低,皮瓣切取成功率高。

abstractsObjective:To evaluate the clinical efficacy of one-stage thinned and modified free anterolateral thigh flap (ALTF) with vascularised fascia lata (VFL) for reconstruction of composite defects of Achilles tendon and surrounding soft tissue.Methods:A retrospective study was conducted on 10 patients treated with thinned and modified free ALTF with VFL for defects of Achilles tendon concomitant with adjacent soft tissue at the Department of Orthopaedics, Guangzhou Heping Orthopaedics Hospital from June 2021 to May 2024. The patients were 8 males and 2 females, aged 16 to 72 years. Soft tissue defect were 3.0 cm×11.0 cm to 6.0 cm×34.0 cm in size, with Achilles tendon defects from 4.0 cm to 7.0 cm in length. Dimensions of ALTF varied from 4.0 cm×12.0 cm to 7.0 cm×35.0 cm. Flap donor sites were directly closed in 5 patients. Wounds at donor sites of other 5 patients were primarily covered by VSD dressing after pulling close with sutures, and followed by secondary wound closure by suture or skin grafting. Postoperative follow-up was conducted through outpatient clinics and via phone calls or WeChat interviews, to monitor early and late complications of surgery, as well as healing of flaps and donor sites.Results:All patients completed follow-up that lasted 1 to 3 years. There was no early postoperative complication. One patient had a hypertrophic scar at flap recipient site and it was managed conservatively. Donor sites healed satisfactorily with linear scars or mild graft-related scarring, without pressing pain. All flaps achieved successful primary survival. Amer-Lindholm criteria were used to assess functional recovery of the reconstructed Achilles tendon, with excellent in 6 patients and good in 4. Range of motion of the affected ankle showed dorsiflexion of 10° to 15° ( vs. 25° of contralateral ankle) and plantar flexion of 20° to 45° ( vs. 45° of unaffected ankle). All patients regained heel lifting. Five patients resumed normal walking and 5 were able to jog. Cosmetic outcomes were evaluated by Vancouver Scar Scale (VSS), which scored 3-6. Functional recovery achieved 87-96 of American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH) and 85-95 of Achilles Tendon Rupture Score(ATRS). Sensory recovery at the flap recipient site were diminished in comparison with adjacent skin. Conclusion:The thinned and modified free ALTF with VFL is a reliable option for reconstructing complex defects involving Achilles tendon and the surrounding soft tissues. It offers tolerance of anatomical variations of vessels, with a high success rate in flap harvest and transfer.