陈旧性跟腱断裂合并皮肤缺损的修复

目的探讨陈旧性跟腱断裂合并皮肤缺损的修复方法。方法通过对1995年2月～2001年12月10例陈旧性跟腱断裂手术病例回顾性随访，分析术式的选择、注意事项及效果。其中采用腓肠肌肌皮瓣3例，足外侧皮瓣4例，内踝上皮支皮瓣2例，腓肠神经皮瓣1例；采用跟腱直接缝合8例，Lindholm法缝合2例。结果所有皮瓣及肌皮瓣均成活，8例愈合良好，2例裂开。跟腱术后功能按尹庆水的疗效评定标准：优5例，可4例，差1例。结论用显微外科技术修复跟腱合并皮肤缺损可取得良好效果，对减少关节挛缩或僵硬，挽救足跖屈及小腿向前推进能力有重要意义。

MICROSURGERY TREATMENT OF OLD ACHILLES TENDON RUPTURE MERGING WITH SKIN DEFECT

Objective To explore the methods of treatment for old achilles tendon rupture merging with skin defect. Methods By following up retrospectively 10 patients from February 1995 to December 2001, we analyzed the operative methods, the points for attention and the results. Gastrocnemius musculocutaneous flaps were used in 3 cases, foot lateral skin flaps in 4 cases, superior medial malleolus skin flaps in 2 cases, and sural neural skin flap in 1 case. The Achilles tendon was sutured directly in 8 patients, with Lindholm's technique in 2 patients. Results All flaps survived and the wound healed well in 8 cases and reruptured in 2 cases. According to Yin Qing shui's criteria to test the efficacy, the results were excellent in 5 patients, good in 4 and poor in 1. Conclusion Repairing the old Achilles tendon rupture merging with skin defect by use of microsurgery has good results and plays an important role in reducing joint contracture and stiffness, and in saving the ability to push forward and flex.