| PART ?:Experimental study of peroneal artery perforator flap with gastrocnemius aponeurosis for repair of old tendon defect in rabbit.Objective: Analyzing the effect of peroneal artery perforator flap with gastrocnemius aponeurosis in repairing the old rabbit Achilles tendon defect effect,to provide experimental basis for clinical treatment.Methods: 60 adult Newzealand white rabbits were divided into three groups randomly.Group A was autologous free Achilles tendon transplantation group,group B was V-Y tendinous flap group,group C was peroneal artery perforator flap with gastrocnemius aponeurosis group.The rabbit model of old Achilles tendon defect was made by excising 2cm tendon.The reconstructive surgery was carried in time of one week after resection.6 rabbits of each group were respectively put to death to obtain specimen of the anastomosis in 2th,4th,8th week.The healing effect was evaluated by histology and biomechnaics analysis.Results: 1.Microvascular observation: at two weeks after operation,neovascularization in B group and C group was higher than that of group A,the difference was statistically significant.At four weeks after operation,the number of new blood vessel reached the peak in three groups,and that of group B and group C higher than group A,the difference was statistically significant.At eight weeks after operation,the neovascularization of three groups was degraded.2.Observation of collagen fibers: At 2th week after operation,three groups were visible a few new collagen fiber and fiber structure was disorder,collagen fiber of group B and C was better than group A.At 4th week after operation,there are a large number of collagen fibers formed in all groups,the density and arrangement of collagen fibers in group B and C is better than that in group A.At 8th week after operation,three groups have plenty of collagen fibers formed,the collagen fibers arranged in dense and direction well in group B and group C.3.Measurement of hydroxyproline content: At 2th week,the contents of hydroxyproline in group C was higher than in group A and group B,the difference was statistically significant.At 4th week and 8th week,the hydroxyproline content of group B and group C was higher than that in group A,the difference is statistically significant.There was not statistically significant difference between group B and group C.4.Biomechanical testing: At 2th week,the maximum tensile strength and tensile stiffness of A group and B were similar(P > 0.05),but were significantly higher than that in C group(P < 0.05).At 4th week,the maximum tensile strength of group B is better than that of group A and C,but the difference was not statistically significant(P > 0.05).The tensile stiffness of group A and C is similar(P > 0.05),but lower than B group(P < 0.05).At 8th week,the maximum tensile strength and tensile stiffness are similar in group B and group C(P > 0.05),but were significantly higher than that in group A(P < 0.05).Conclusions: For old Achilles tendon defect,Sural neurocutaneous flap with gastrocnemius aponeurosis is a vascularized repair method.The new microvascular,collagen fiber quality,hydroxyproline content,mechanical strength of anastomosis were similar with V-Y tendinous flap,and better than that of autologous free Achilles tendon transplantation.PART ?:A clinical study of complex tendon defect repaired by peroneal artery perforator flap with gastrocnemius aponeurosis.Objective: To retrospectively analyze the clinical experience of repairing complex Achilles tendon defect with Sural neurocutaneous flap combined gastrocnemius aponeurosis.To seek out a kind of surgical approach with little injury and can solve the achilles tendon and surgical skin defection at the same time.Methods: Between 2012 May and 2015 March,19 cases of complex Achilles tendon defects were repaired with Sural neurocutaneous flap combined gastrocnemius aponeurosis.7 cases were fresh injury,12 cases were old defects.19 cases of Achilles tendon defects were accompanied by skin and soft tissue necrosis.The size of the wounds ranged from 4.0 cm × 6.0cm to 6.0 cm × 12.0 cm.The length of tendon defect ranged from 5cm to 9cm.The size of the flaps ranged from 6 cm × 5.5 cm to 12 cm × 8 cm.The size of gastrocnemius aponeurosis ranged from 5.5 cm × 6 cm to 10 cm × 6 cm.The donor sites were covered with intermediate split thickness skin grafts.The objective evaluated index was range of plantar flexion and dorsal flexion and morphology.The subjective evaluation was obtained by AOFAS scores and SF36 scores.Results: 15 cases reconstructive achilles tendon survived well.2 cases with skin necrosis and 1 cases with donor site necrosis.1 cases experience recurrent infection.Nineteen patients were followed up 6-24 months(mean,18 months).All patients had no abnormal gait and plantar flexion deformity.The function of heel is good with standing on toes and toe walking.The plantar extension at 1year after operation was significantly larger than that at 3 months after operation and pre-operation(P<0.05).The dorsal extension at 1year after operation was significantly larger than that at 3 months after operation(P<0.05),but no significant difference was found between at 1 year and pre-operation(P>0.05).The AOFAS score and SF36 score at 1year after operation were significantly larger than those at 3 months after operation and pre-operation(P<0.05).Conclusions: Peroneal artery perforator flap with gastrocnemius aponeurosis was an ideal repair method in repairing complex Achilles tendon defect.The method had the character of less trauma,excellent blood supply and wide surgical indication. |
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