阔筋膜移植治疗陈旧性跟腱断裂

目的总结采用阔筋膜移植治疗陈旧性跟腱断裂的疗效。方法对16例患者采用阔筋膜移植修复陈旧性跟腱断裂并随访。结果全部病例均经2～3年,平均28个月的随访,按Arner—Lindhohm评定标准判定,优12例,良3例,差1例,临床优良率达93．8％。结论阔筋膜移植治疗陈旧性跟腱断裂是一种效果较好的方法。     

胭绳肌腱移植修复陈旧性跟腱断裂

目的 介绍腘绳肌腱移植修复陈旧性跟腱断裂的方法和经验.方法 对15例陈旧性跟腱断裂采用胭绳肌腱移植修复.结果 随访6～15个月,平均9个月,采用Arner-Lindholmliao疗效评定标准:优12,良3例.结论 采用胭绳肌腱移植治疗陈旧性跟腱断裂是一种较好的方法,值得推广.     

腘绳肌腱移植修复陈旧性跟腱断裂

目的介绍腘绳肌腱移植修复陈旧性跟腱断裂的方法和经验。方法对15例陈旧性跟腱断裂采用腘绳肌腱移植修复。结果随访6-15个月,平均9个月,采用Amer—Lindholmliao疗效评定标准：优12,良3例。结论采用腘绳肌腱移植治疗陈旧性跟腱断裂是一种较好的方法,值得推广。     

改良Bosworth法联合应用可吸收防粘连膜对陈旧性跟腱断裂的治疗和护理

目的 探讨改良Bosworth法联合应用可吸收防粘连膜治疗陈旧性跟腱断裂的护理与康复训练方法及效果。方法 对14例陈旧性跟腱断裂患者采用改良Bosworth法重建后，可吸收防粘连膜包绕肌腱的术式，结合围术期皮肤软组织护理以及渐进性的康复训练治疗陈旧性跟腱断裂。结果 平均随访29个月，按疗效评定标准评估，优12例，良2例。结论 我们认为对陈旧性跟腱断裂的治疗，不但要有优良的术式，同时良好的围术期皮肤软组织护理以及正确的康复训练非常关键。     

陈旧性跟腱断裂合并皮肤缺损的一期修复

陈旧性跟腱断裂合并皮肤缺损的治疗较为复杂，常规治疗应在局部创面愈合后３个月行二期跟腱修复。１９８５年６月～１９９６年６月采用自体肌腱或筋膜瓣移植修复跟腱，同时用伤肢邻近带血管、神经蒂岛状皮瓣覆盖，石膏托外固定，治疗陈旧性跟腱断裂合并皮肤缺损１８例。结果表明，创面Ⅰ期愈合１６例，移植皮瓣远端皮缘坏死０．５ｃｍ～１ｃｍ的２例，经早期修复治愈。术后１年以上随访１５例，其中１２例关节功能恢复正常，３例跟腱与邻近组织粘连，影响踝关节过度背屈，足部蹬力下降。认为，采用肌腱或筋膜瓣加带血管神经蒂岛状皮瓣一期修复陈旧性跟腱断裂合并皮肤缺损，可缩短疗程，减轻患者的痛苦和经济负担，更快恢复伤肢的功能     

四股胭绳肌腱经跟骨隧道移植与腓骨长肌转位治疗陈旧性跟腱断裂的疗效比较

背景：多数学者认为陈旧性跟腱断裂应行手术治疗。目前,手术修复缺损的方法多种多样。目的：比较四股胭绳肌腱经跟骨隧道移植与腓骨长肌转位修复陈旧性跟腱断裂的临床疗效。方法：2002年3月至2009年12月收治陈旧性跟腱断裂患者29例,均为单侧陈旧性跟腱完全性断裂。应用四股胭绳肌腱经跟骨隧道移植修复16例（A组）,应用腓骨长肌转位修复13例（B组）。术后两组均常规使用抗生素,并行功能锻炼,采用Arner-Lindholm标准评价治疗效果。结果：两组患者均获得随访,随访时间24-60个月,平均39个月。按照Amer-Lindhohm评定标准判定,A组：优15例,良l例,临床优良率达100％。B组：优9例,良3例,差1例,临床优良率达92．3％。A组优于B组,差异有统计学意义（P〈0．05）。结论：四股胭绳肌腱经跟骨隧道移植与腓骨长肌转位术均是治疗陈旧性跟腱断裂的有效方法,但前者优于后者,值得临床推广应用。     

应用同种异体肌腱移植修复陈旧性跟腱断裂

目的探讨应用同种异体肌腱移植修复陈旧性跟腱断裂的手术方法. 方法 1996年7月～2000年11月,对6例陈旧性跟腱断裂患者行经过深低温处理的同种异体屈指肌腱移植.在跟腱近、远断端间立体双8字交叉移植进行修复,恢复跟腱断端的连续性和强度. 结果术后6例中有5例获2年以上随访,时间27～53个月.5例切口Ⅰ期愈合,1例切口皮缘坏死,经换药愈合.采用Arner-Lindholm疗效评定方法评估获随访的5例术后功能,优1例,良4例. 结论异体肌腱移植修复陈旧性跟腱断裂,可避免自体取材造成的损伤及可能引起的并发症,供材可提前制作,缩短了手术时间,是一种可行的手术方法.     

腓骨长肌腱和跖肌腱膜片修复陈旧性跟腱断裂

[目的]总结腓骨长肌腱和跖肌腱膜片治疗陈旧性跟腱断裂的方法和经验。[方法]将腓骨长肌止点处切断，经皮下遂道移位修复陈旧性跟腱断裂，跖肌腱膜片包绕缝合跟腱后侧形成光滑面。[结果]13例患者术后随访6个月-3年，获得了良好的疗效。[结论]腓骨长肌移位和跖肌腱膜片覆盖是治疗陈旧性跟腱断裂的一种有效方法。     

腓肠肌腱膜瓣翻转联合阔筋膜移植治疗跟腱再断裂

目的:探讨腓肠肌腱膜瓣翻转联合阔筋膜移植修复跟腱再断裂的临床疗效。方法 :自2013年7月至2017年4月,对11例跟腱术后再断裂患者采用腓肠肌腱膜瓣翻转联合阔筋膜移植重建治疗,男10例,女1例;年龄25～48岁。所有患者术前患足跖屈力量减弱、单足提踵试验阳性。观察术后并发症,并于术后6个月采用美国足踝外科学会踝-后足功能评分(AOFAS)进行功能评价。结果:本组11例患者获得随访,时间6～11个月。所有患者手术切口均Ⅰ期愈合,无皮肤坏死、切口感染、深静脉血栓、再断裂等并发症。跟腱缺损长度4～7 cm。患者完全恢复负重时间8～11周。术后6个月AOFAS评分79～100分,其中优9例,良2例。结论:腓肠肌腱膜翻转联合阔筋膜移植修复跟腱再断裂,具有跟腱修复可靠,并发症少,跟腱功能恢复良好的优点,是一种有效的临床治疗方法。     

陈旧性跟腱断裂并感染的手术治疗

Ｇａｒｄｅｎ等把受伤后１周作为急性、陈旧性跟腱断裂的界限［１］，陈旧性跟腱断裂往往是急性跟腿断裂保守治疗失败、误诊、处理不当造成［２］。我院１９９３年２月～１９９６年９月，收治陈旧性跟腱断裂并感染病例８例，行手术治疗及术后康复指导，随访８个月～２年，...     

Interwoven wire suture with fascia lata-plasty in the treatment of subcutaneous rupture of the Achilles tendon--an obsolete method?

Lately there has been an increased incidence of rupture of the Achilles tendon following the general increase in mass sports. Surgery is the treatment of choice, and various methods are being described. We have been using the wire suture method with fascia lata plasty for more then twenty years. The rate of infection is 3.8% and that of rerupture 1.2%, figures that correspond to those stated for other surgical methods. Moreover, 87% of the patients were very satisfied with the result of the operation; they are fit for work without any restriction, and some of them even practise their sports activities as before. For this reason we consider that wire suturing with fascia lata plasty is by no means obsolete in the treatment of rupture of the Achilles tendon.     

Reconstruction of the Achilles tendon and overlying soft tissue by free composite anterolateral thigh flap with vascularized fascia lata

Segmental loss of the Achilles tendon with overlying soft tissue and skin defect remains a complex reconstructive challenge. Successful reconstruction combines tendon repair with coverage of the defect by soft tissue flaps, creating an entity that meets up to three predetermined goals: (1) approaching preinjury functionality, (2) resisting shearing forces, and (3) achieving an esthetic result. From June 2009 to June 2011, our center submitted six patients to a one-stage procedure correcting the Achilles tendon using a composite free anterolateral thigh (ALT) flap with vascularized fascia lata. The flap sizes ranged from 5 to 8 cm in width and 16 to 20 cm in length and all flaps included vascularized fascia lata which was rolled to serve as an Achilles tendon. After reconstruction our patients showed good functional results, these patients could walk, climb stairs, and tiptoe again without support. Moreover, normal footwear could be worn. A free composite ALT flap with vascularized fascia lata is a reliable option for coverage of Achilles tendon and overlying soft tissue defects, even in elderly patients.     

腓肠肌腱膜翻转术在陈旧性跟腱断裂中的应用

目的探讨应用腓肠肌腱膜翻转法治疗陈旧性跟腱断裂的疗效。方法对18例陈旧性跟腱断裂患者应用腓肠肌腱膜翻转术重建跟腱。术中于小腿中部腓肠肌腱膜-肌移行处切取一条长8～10 cm、宽3 cm带蒂腓肠肌筋膜瓣,其基底留在离断端上方约1.5～2 cm处,于蒂上方跟腱中心作一纵切口,把腱膜瓣从此切口中穿过,再反折向下,由跟腱两侧向浅面包绕跟腱远近端及其缺损。自跟骨结节撕脱者将跟骨结节咬成粗糙面,腱膜条拉紧,根据缺损长度修剪腱膜条远端,使之与跟骨结节相接触。然后用Bunnell抽出钢丝法将重建跟腱拉紧,使踝关节跖屈约20°。结果本组有3例切口延迟愈合,无皮肤及肌腱坏死、无深部感染及再断裂病例。所有患者平均随访26（24～40）个月,按Arner-Lindholm标准评定,优13例,良5例,临床疗效良好。结论腓肠肌腱膜翻转术治疗陈旧性跟腱断裂具有手术操作简单、固定牢固、愈合率高、并发症少等优点,是一种较为理想的重建方法。     

Use of the medial upper arm fascia to bridge biceps tendon defects

Options to bridge biceps tendon defects which have been described in the literature include fascia lata, semitendinosus tendon, flexor carpi radialis, Achilles tendon-calcaneus composite allografts and Achilles tendon allografts. In this study, the author reports the use of the upper arm fascia. This option is considered most suitable for patients who require simultaneous pedicled latissimus dorsi flap coverage of concurrent traumatic complex anterior elbow defects.     

Extensive Achilles tendon ossification: Repair using a fascia lata graft

Ossification of the Achilles tendon is a relatively common finding. However, a large ossification covering more than two third of the tendon is rarely seen. A 70 year old patient with a 12 cm long Achilles tendon ossification is discussed. The ossification was surgically removed and the tendon was subsequently reconstructed using a fascia lata autograft. Postoperatively the ankle was immobilised for 3 months. One year postoperatively the patient was completely recovered with the ability to stand on his toes, and minimal loss in range of motion.Level of clinical evidence4     

Reconstruction of the achilles tendon and overlying skin defect with a medical plantar flap and tensor fasciae latae graft

The authors report a case of Achilles tendon and skin defect treated with an island medial plantar flap and fascia lata graft with very satisfactory results.     

Quadriceps tendon reconstruction using a fascia lata included in a reverse‐flow anterolateral thigh flap

Quadriceps tendon re‐rupture after surgical repair is an overall estimated 2% complication. We report a case of reconstruction in a large tendon and soft tissue defect using a reverse‐flow anterolateral thigh (ALT) perforator flap including fascia lata in a 75‐year‐old man presented with septic necrosis of a reconstructed quadriceps tendon. A reverse‐flow ALT flap was transferred to the knee defect; the fascia lata was sutured to the residual tendon. Post‐operative flap congestion and infection were successfully treated with debridement and conservative treatment. One year after surgery, the patient was able to fully and actively extend the knee, with an acceptable aesthetic appearance. The reverse‐flow anterolateral thigh flap including fascia lata may be a good option for coverage of soft‐tissue defects around the knee and contemporary quadriceps tendon reconstruction, particularly in case of septic tendon necrosis, where the use of non‐vascularised tissues is contraindicated.     

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

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.     

Reconstruction of Achilles tendon using vascularised fascia lata with free lateral thigh flap

A case of Achilles tendon reconstruction using free vascularised fascia lata joined to a lateral thigh flap is reported. This is a simple one-stage reconstruction and a sufficiently strong tendon can be obtained.