Dorsalis Pedis Artery-based Flap to Cover Nonhealing Wounds Over the Tendo Achillis—A Case Series: 用足背動脈蒂皮瓣來覆蓋非癒合的跟腱手術傷口—系列病例報告

Background/PurposeSoft tissue necrosis after the repair of a ruptured tendo Achillis is a difficult problem commonly encountered by orthopaedic surgeons. Such wounds are difficult to manage because of the tenuous blood supply and the characteristic anatomical features of the area. Flaps such as the reverse sural flap, medial plantar flap, gastrocnemius flap and free flaps cover such wounds with a good success rate. The aim of our study was to investigate the use of a dorsalis pedis artery (DPA)-based flap to cover a wound over the tendo Achillis insertion area.MethodsWe report a series of 11 patients in whom wounds over the tendo Achillis insertion area were covered with a DPA-based flap. Between 1995 and 2012, 11 patients (nine men and two women), who were referred to us with a nonhealing wound over the tendo Achillis because of soft tissue necrosis after the open repair of a ruptured tendon, were selected for soft tissue coverage of the wound by using a DPA-based flap.ResultsThe average follow-up period was 2.4 years (range, 1–6 years). The mean operative time was 1.7 hours (range, 1.5–2.0 hours). At the latest follow-up examination, the flaps had survived in all patients.ConclusionA DPA-based flap is a good and relatively less complex procedure to use to cover defects over the tendo Achillis with minimum donor site morbidity.

中 文 摘 要背景跟腱修補手術的傷口出現軟組織壞死,是骨科醫生常見到但很難處理的併發症。由於該區域的脆弱的血液供應和解剖特徵,使傷口難以處理。文獻中已經描述了許多不同的皮瓣,例如反向腓腸皮瓣,內蹠側皮瓣,腓腸肌皮瓣以及一些游離皮瓣來覆蓋這些傷口,都有良好的成功率。我們本研究的目的,是調查用足背動脈蒂皮瓣(Dorsalis Pedis artery based flap, DPA flap)來覆蓋這些跟腱手術傷口的成效。方法從1995 年到2012 年,一系列共11 病例(9 男2 女)接受了DPA flap 來覆蓋跟腱修補手術後不能愈合的傷口。結果隨訪時間平均為2.4 年(範圍由1-6 年)。手術時間平均為1.7 小時(範圍由1.5 至 2 小時)。在最後的隨訪,所有的病例的皮瓣都存活。結論用DPA flap 來覆蓋跟腱傷口有很好的果效,步驟簡單而且對供皮區的傷害很少。