改良膝降动脉为蒂大收肌腱骨皮瓣修复跟腱复合组织缺损

目的　探讨改良膝降动脉为蒂的大收肌腱骨皮瓣修复跟区跟腱复合组织缺损方法及效果。 方法　对3例外伤致足跟区跟腱止点伴跟骨及皮肤软组织缺损的患者，采用以膝降动脉为蒂的隐动脉穿支皮瓣修复跟区皮肤缺损，以膝降动脉关节支为蒂的大收肌腱骨瓣移植修复跟区复合组织缺损。其中跟区皮肤缺损面积为7 cm×9 cm～5 cm×7 cm ,跟腱缺损长度为6～8 cm，切取皮瓣面积为8 cm×10 cm～6 cm×8 cm ，大收肌腱切取长度为7～9 cm。 结果　3例复合组织瓣全部顺利成活，术后随访6～12个月，皮瓣感觉恢复S3～4，双足提踵试验及单足提踵试验均阴性，步态恢复均正常。 结论　应用隐动脉穿支设计皮瓣,皮瓣设计于大腿内侧, 改良了隐动脉皮瓣设计于小腿内侧，造成切口过大，分离血管蒂较长等缺点,疗效可靠，是目前较理想修复方法。

Repair of Achilles tendon composite defect using osteocutaneous flap of adductor magnus tendon pedicled with

Objective　To evaluate clinical effects of osteocutaneous flap of adductor magnus tendon pedicled with descending genicular artery on repair of Achilles tendon composite defect.　Methods　Osteocutaneous flap of adductor magnus tendon pedicled with descending genicular artery were individually designed and surgically used on 3 cases with traumatic Achilles tendon defects, combined with soft tissue and calcaneal bone damage. The area of skin defect was ranged from 7 cm×9 cm to 5 cm×7 cm, and the length of Achilles tendon defect was 6 ~ 8 cm. During the operation , the flaps was designed as 8cm×10cm to 6cm× 8cm, with the cutting length of the adductor magnus tendon 7~ 9 cm . Results: All 3 cases were followed-up for 6 to 12 months. The transplanted tissue flap survived well. The texture, appearance and function of the flap were excellent.　Conclusions　It is a ideal way to repair of Achilles tendon composite defect, using osteocutaneous flap of adductor magnus tendon pedicled with descending genicular artery, which avoiding the severe surgical trauma and the extended isolation of vessels.