带血管蒂腓肠肌内侧头肌瓣转移重建髌腱的长期随访

Objective To evaluate the long following-up outcome of the medial gastrocnemius muscle transferring reconstruction the patella tendon after the wide resection of aggressive bone tumors in the proximal tibia. Methods With the 69 patients of the osteogenetic sarcoma in the proximal tibia were treated with the wide resection and reconstruction the patella tendon. After the long following up the knee extensor,function and complications were evaluated. Results With the 69 patients, the 45 survival patients were followed up for the average 68.6 (24-128) months. The local recurrence rate was 8.7%(6/69). The strength of knee extending was in the average of grade 4.2(3.6-5.0), the degree of knee flexion was in the average of 95°(75°-135°), the degree of knee extension was in the average of-2°(0°-12°), the knees of five patients cannot fully extension. The MSTS functional score was in the average of 77% (23.1/30). Conclusion During the limb salvage of the proximal tibial aggressive bone tumors, the medial gastrocnemius muscle transferring reconstruction the patella tendon could offer the knee extension strength; improve the soft tissue coverage and functional results.     

带血管蒂腓肠肌内侧头肌瓣转移重建髌腱的长期随访

Objective To evaluate the long following-up outcome of the medial gastrocnemius muscle transferring reconstruction the patella tendon after the wide resection of aggressive bone tumors in the proximal tibia. Methods With the 69 patients of the osteogenetic sarcoma in the proximal tibia were treated with the wide resection and reconstruction the patella tendon. After the long following up the knee extensor,function and complications were evaluated. Results With the 69 patients, the 45 survival patients were followed up for the average 68.6 (24-128) months. The local recurrence rate was 8.7%(6/69). The strength of knee extending was in the average of grade 4.2(3.6-5.0), the degree of knee flexion was in the average of 95°(75°-135°), the degree of knee extension was in the average of-2°(0°-12°), the knees of five patients cannot fully extension. The MSTS functional score was in the average of 77% (23.1/30). Conclusion During the limb salvage of the proximal tibial aggressive bone tumors, the medial gastrocnemius muscle transferring reconstruction the patella tendon could offer the knee extension strength; improve the soft tissue coverage and functional results.     

部分背阔肌皮瓣游离移植修复前臂背侧组织缺损并重建伸指功能

Objective To report the operative methods and clinical effects of free transfer of part of the latissinus dorsi flap for coverage of dorsal forearm composite tissue defects and reconstruction of extensor function. Methods Eleven cases of large-scale composite tissue defects of the dorsal forearm as a result of trauma were treated with partial latissimus dorsi flap The medial portion of the myoeutaneou flap containing the medial thoracodorsal nerve branch Was transferred to the defect on dorsal forearm.The thoracodorsal nerve in the flap was sutured either to the radial nerve deep branch or to the extensor comnunis muscle branch.The distal aponeurosis of the latissimus dorsi woven to the tendons of the 2nd to 4th digit extertsors.The size of the harvested flaps ranged from 21 cm×9 cm to 27 cm×13 cm. Results Postoperatively all 11 myocutaneous flaps survived.Three cases underwent trimming of the cutaneous flap or myocutaneous flap due to bulkiness.Two cases had tendon tighteing procedures due to laxity of the extensor tendon.Nine eases were followed up for 6 months to 3 years,while 2 cases were lost to follow up.The extensor strength returned grade Ⅲ in 2 cases,grade Ⅳ in 6 cases grade Ⅴ in 1 case.The limb function was mostly restored and the appearance was satisfactory.According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association the results were rated as excellent in 2 cases,good in 5 cases,and fair in 2 cases.The overall excellent and good rate was 77.8%. Conclusion Partial transfer of the latissimus dorsi myocutaneous flap for coverage of dorearm forearm composite tissue defects and reconstruction of extensor function can not only achieve good treatment outcomes,but retain some of the latissimus dorsi function as well.     

A follow-up study of arthroscopic combined reconstruction of anterior and posterior cruciate ligaments with allograft patellar tendon

Objective： To evaluate the therapeutic effect of combined reconstruction of anterior cruciate ligament （ ACL ） and posterior cruciate ligament （ PCL ） simultaneously by using allograft patellar tendon under arthroscopy. Methods： From May 2003 to November 2005, 10 cases of ruptured ACL and PCL were fixated with compressed screws and reconstructed under arthroscopy with allograft patellar tendon simultaneously. The clinical results were evaluated according to IKDC, Lysholm, and Tegner clinical rating scales. Results. All patients were followed up for 12-30 months （mean： 18 months ）. At the last follow-up, there was no knee extension limitation and knee flexion was between 120° and 135°, with an average of 128.38°. The Lysholm score of the 10 cases was 66. 5 ± 5. 6 before operation and 89.8 ± 3.4 at last follow up. The difference was statistically significant （ P 〈 0.01 ）. The average Tegner activity score decreased from 6.9 ± 1.7 （ range ： 4-9 ） before injury to 5.5 ± 1. 6 （rang： 2-9） at the follow-up （P=0.53）. At the end of follow-up, IKDC score was graded as A in 4 cases （40.0 % ）, B in 5 （50.0 % ）, and C in 1 （10.0%）. Of the 10 patients, 8 returned to the same sports level as before injury and 2 were under the level. Conclusion. Arthroscopic combined reconstruction of ACL and PCL with allograft patellar tendon has the advantages of minimal trauma in surgery and reliable satisfactory outcome.     

Clinical study of reconstructing the medial malleolus with free grafting of fibular head composite tendon bone flap

Objective： To explore new surgical procedure for repairing and reconstructing medial malleolus and soft tissue defect.
Methods： According to the size of medial malleolus and composite soft tissue defect, vascular fibular bead composite tendon bone flap free wafting using anterior tibial recurrent vessel as the perforating branch was designed to reconstruct the medial malleolar saddle and triangular ligament, and composite back broadest muscle flap free grafting was designed to repair the medical malleolar wound surface. From January 2000 to December 2006, the technique was used in 5 male patients who were injured by machine or in traffic accidents, causing bone and soft tissue defect. The size of wound surface ranged from 19 cm×12 cm to 24 cm×12 cm.
Results： The wound surface was healed at the first stage in 4 cases, and the other case had infection and was cured in 6 months with anti infection therapy. Postoperative foUow-ups from 6 months to 6 years showed that grafted bones and free cutaneous flaps were healed well, malleolar joints were stable, joint movement was normal, and the appearance was satisfactory. The overall outcome was good.
Conclusion ： Fibular head composite tendon bone flap free grafting is effective for repairing medical malleolar defect.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

Management of Acute Achilles Tendon Rupture Using the Krackow and Tendon-Bundle Techniques

Background Acute Achilles tendon rupture is a severe injury of the lower extremities;however,optimal treatment options are not yet available.This study aimed to investigate the surgical method and clinical effect of the Krackow and tendon-bundle techniques for managing acute Achilles tendon rupture.Methods This retrospective case series study analyzed 17 cases of acute Achilles tendon rupture at the Beijing Jishuitan Hospital from December 2012 to January 2020.There were 16 men and one woman,aged 27–45 years,with an average of 39.6 years.Thirteen patients were injured while playing basketball or badminton,and 4 patients were injured while participating in a football match or other sports.All injuries were repaired using the Krackow and tendon-bundle techniques.Postoperative evaluation indicators included active range of motion during ankle plantar flexion and dorsiflexion,height of single foot heel lifting,Amer-Lindholm Achilles tendon function score,and American Orthopedic Foot and Ankle Society(AOFAS)score.Results The patients were followed-up for 6–45 months(average,18.9 months).There was no re-rupture of the Achilles tendon,wound infection,or sural nerve injury.At the final follow-up,the affected and contralateral sides exhibited plantar flexion of 42.1±4.4°and 43.8±2.8°,dorsiflexion of 15.8±2.9°and 16.6±2.9°,respectively,and one foot exhibited a heel lifting height of 7.2±1.0 cm and 7.5±0.9 cm,respectively.There was no significant difference between the affected and contralateral sides(P>0.05).At the final follow-up,the Amer-Lindholm Achilles tendon function score was excellent in 94.1%(16/17)of the patients and good in 5.9%(1/17)of the patients.The AOFAS scores ranged from 90 to 100,with an average of 96.4±3.7.Conclusion Krackow and tendon-bundle techniques can improve the strength of the suture used for the Achilles tendon repair and ensure good matching for broken ends,and thus it is an effective repair method for closed Achilles tendon injury.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

腓动脉穿支腓肠神经营养血管游离皮瓣修复手足软组织缺损

Objective To report the operative techniques and clinical results of the free psroneal artery perforator sural neurecutanecus flaps. Methods Free sural neurocutaneous flap with a single unit of perforating veins and artery arising from the peroneal artery was designed to repair skin defects of hand or from the ankle to distal end of the foot. After the flap was transposed to the defect, the perforating artery was anastomozed with a branch of a nearby artery, and the small saphenoas vein was anastomosed with the cephalic vein or the great sapheneous vein to establish the flap's circulation. An alternative way was to anastomose the perforating vessels only. The sural nerve was anastomosed to innervate the flap. Results From Jan 2005 to Dec 2007, 12 cases were treated with the flaps with no flap necrosis. The size of the flaps ranged from 12 crux7 cm to 18 cm× 11 cm. The follow-up period was 7 to 27 months. Both the cosmetic and functional results were satisfactory. Two point discrimination was 7 ～ 12 mm. Conclusions The flap has all the advantages of the h'ee flap, the perforator flap and the neurocutaneous flap. It is easily performed with reliable blood supply. It's a good choice for repairing the skin defects of hands and feet.     

跟腱伴皮肤缺损的一期腓肠肌肌皮瓣修复

目的介绍腓肠肌推进皮瓣一期修复跟腱伴腱周皮肤缺损的方法。方法对8例跟腱伴腱周皮肤缺损,采用双蒂腓肠肌皮瓣V-Y推进下移修复。结果随访4个月～6年。8例缺损均一期愈合。患肢均恢复行走能力。膝踝功能满意。结论双蒂腓肠肌皮瓣V-Y推进下移可一期修复跟腱伴腱周皮肤缺损。     

Die Musculus-gastrocnemius-Lappenplastiken

OBJECTIVE: Defect reconstruction by transposition of well-vascularized muscle (muscle flap) or muscle/skin tissue (myocutaneous flap). Reconstruction of missing muscle unit by free functional muscle transplantation. INDICATIONS: Treatment of first choice for defect coverage at the distal thigh, knee (including exposed and infected total knee prosthesis), and proximal lower leg. CONTRAINDICATIONS: Lesions of the popliteal artery. Concomitant lesion of the soleus muscle (impaired plantar flexion). SURGICAL TECHNIQUE: Proximally pedicled flap: the distal tendinous insertion of the medial and/or lateral gastrocnemius muscle at the Achilles tendon is cut. Vascularization is assured by the medial and lateral sural artery, respectively. - Muscle flaps (medial gastrocnemius, lateral gastrocnemius). - Muscle-skin (myocutaneous) flaps. Distally pedicled flap: the proximal tendinous origin of the medial or lateral gastrocnemius muscle is cut. Vascularization is assured by vascular anastomoses between the two muscles crossing the midline. Because of its unpredictable vascularization, especially after trauma, this technique is rarely used today. To improve arterial inflow, the cut sural artery can be anastomosed in microsurgical technique with an adequate arterial blood vessel at the recipient site. POSTOPERATIVE MANAGEMENT: Complete immobilization for 5-7 days (knee and ankle joints). Progressive increase of range of motion after 1 week (30 degrees /45 degrees /60 degrees /90 degrees ). Postoperative standardized compression therapy, combined with scar therapy (silicone sheet). RESULTS: Reliable, excellent functional and aesthetic results.     

Surgical reconstruction of chronic achilles tendon ruptures using various methods

The purpose of this study was to evaluate the surgical outcomes of reconstruction of chronic Achilles tendon ruptures using various methods, including Achilles tendon allograft. Between October 2003 and March 2010, twelve patients with chronic Achilles tendon ruptures and a defect gap of >4 cm underwent surgical reconstruction with V-Y advancement, gastrocnemius fascial turn-down flap, flexor hallucis longus tendon transfer, or Achilles tendon allograft. The study group comprised 11 men and 1 woman. At last follow-up, all patients were assessed with regard to postoperative complications, self-reported level of satisfaction, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon Total Rupture Score, repetitive single-heel rises, single-leg hopping test, and ankle range of motion. The AOFAS scores increased from an average of 68.7 (range, 50-87) preoperatively to 98.0 (range, 88-100) postoperatively. All patients were able to perform 10 repetitive single-heel raises and single-leg hops at last follow-up. No patient experienced wound complications or deep infection. Seven patients were rated as excellent, 4 as good, and 1 as fair. Chronic Achilles tendon ruptures can be successfully treated by careful selection of the reconstruction method according to the length of defect gap and state of the remaining tissue. With an extensive defect, use of an Achilles tendon allograft can be a good option.     

Vastus medialis muscle flap and hemi V-Y skin flap for knee extensor and soft tissue reconstruction

Simultaneous reconstruction of extensor mechanism and skin defect of the knee joint is a difficult problem. We present a case of a 55-year-old man with loss of patella and 9 x 6 cm skin defect after total patellectomy for infected open patellar fracture. Vastus medialis muscle flap and hemi V-Y skin flap were elevated. Vastus medialis muscle flap was advanced and sutured to the remaining patellar tendon. Hemi V-Y skin flap covered the skin defect. The wound healed uneventfully. After a follow-up period of 30 months, active range of motion of the knee joint is 0-120 degrees, and extension strength of the knee joint is [4] in a manual muscle test. He can stand on his right leg without any assistance. The combination of vastus medialis flap and hemi V-Y skin flap is a valuable option in knee reconstruction after total patellectomy.     

Reconstruction of Achilles tendon defect with a free quadriceps bone-tendon graft without anastamosis

We report a method of Achilles tendon reconstruction using a free quadriceps bone-tendon graft. The patient had a prior repair of a re-ruptured Achilles tendon, following which he developed massive necrosis of his skin and Achilles tendon leaving a 10 cm defect. First stage reconstruction consisted of soft tissue coverage of the skin defect with a sural fasciocutaneous flap. Reconstruction of the Achilles tendon followed, with the patellar bone block fixed to the calcaneus and the quadriceps tendon sutured proximally.     

跟腱再断裂的修复重建

 目的 总结跟腱再断裂的原因, 探讨野V-Y冶推进瓣及长屈肌腱(flexor hallucis longus, FHL)转位修复重建跟腱再断裂的适应证、疗效及其相关并发症。方法 2006年 3月至 2010年 1月手 术修复重建跟腱再断裂患者 16例 16足, 男 12例, 女 4例;年龄 35~72岁, 平均 50.9岁。再断裂距初次 手术时间为 6~49周(平均 21.8周), 随访时间 6~52个月(平均 27.5个月)。充分清除断端瘢痕及坏死组 织4例断端缺损4 cm者采用 FHL转位修 复重建。结合患者病史、康复方式及再次手术术中所见跟腱形态, 分析其发生再断裂原因。观察术后局 部外观及功能恢复情况, 并采用美国足踝外科协会踝-后足评分(American Orthopaedic Foot &; Ankle Society-ankle and hindfoot score,AOFAS-AH)及 Leppilahti跟腱修复评分进行疗效评价。结果 跟腱再 断裂的原因主要为手术切口感染、术后跟腱愈合不良发生液化坏死、术后过早负重或活动不当致跌倒。 采用野V-Y冶推进瓣或 FHL转位修复跟腱再断裂术后局部外观及功能恢复良好, AOFAS-AH评分从术前 (70.2±8.5)分提高到(92.4±6.1)分;Leppilahti跟腱修复评分从术前(74.8±6.2)分提高到(91.7±4.8)分。踝 部 MRI显示跟腱部信号均匀, 无撕裂或积液表现。结论 跟腱再断裂后需彻底清创, 导致大范围缺损。 腓肠肌腱膜野V-Y冶推进瓣可修复4 cm的缺损, 术后踝足部功能外形恢复良好。     

The sural artery perforator flap for coverage of defects of the knee and tibia

We reconstructed four knee and lower leg defects using the sural artery perforator flap between 2000 and 2003, and describe them here. The sural artery perforator flap can save the gastrocnemius muscle, its motor nerve, deep fascia, lesser saphenous vein, and sural nerve with no functional loss. Intramuscular dissection of the perforator achieves increased length of the pedicle compared with a conventional gastrocnemius myocutaneous flap. The flap is thin, and either the medial or lateral sural artery may be used. The flap is suitable in selected cases for regional reconstruction around the knee and upper half of the lower leg as a pedicled flap.     

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。     

Repair of neglected Achilles tendon ruptures: procedures and functional results

Surgical repair of neglected Achilles tendon ruptures presents the challenge of restoring the function of the Achilles tendon complex while repairing the large defect that is created by the delay in appropriate treatment. We present our preferred technique for delayed repair and the results of six patients who were available for complete follow-up evaluation. The combined surgical technique includes: V-to-Y gastrocnemius recession or advancement, excision of the fibroadipose defect, end-to-end anastomosis, gastrocnemius aponeurotic flap to reinforce the anastomosis. Each of six patients were interviewed and examined clinically and by Cybex II isokinetic strength testing. All six patients have been able to return to their pre-injury activities. Cybex II isokinetic strength testing demonstrated peak torque deficiencies in plantar flexion ranging from 2.5%–22% as compared with the unaffected limb. The overall results of the technique described indicate that very satisfactory functioning of a neglected Achilles tendon rupture can be obtained.     

带跟腱的腓肠肌内侧头肌皮瓣修复膝前软组织与髌腱缺损

目的：探讨膝部皮肤软组织髌腱缺损的修复方法。方法：利用带跟腱的排肠肌内侧头肌皮瓣移位进行修复，其中跟腱重建髌腱，肌皮瓣覆盖皮肤软组织缺损。临床应用13例（14肢）。结果：平均随访48．4月,样节活动正常。除1例膝部功能轻度受限外（原发损伤广泛合并复杂骨折），余功能基本正常。结论：该方法治疗此类损伤符合生理要求，且重建修复手术一次完成。