Microsurgical Basis And Clinical Study Of The Achilles Tendon Defect Repair

The rupture or defect caused by traffic accidents, tumor arid sports are reported more frequently in recent literature. This is chiefly because of the development of the traffic and general participation of the physical activities. The Achilles tendon defect, including the soft-tissue of the posterior aspect of the ankle or calcaneus, usually occurred in the traffic accidents. The combined loss is particularly difficult to reconstruct. To explore the treatment methods and effects of the Achilles tendon defect, this study was carried out in the anatomic basis, animal experiment and by clinical microsurgical reconstruction. Materials and Methods The origin, course, branches and distribution of the descending genicular artery were observed on 40 adult cadaveric lower limbs perfused with latax, the morphology and blood supply of the adductor magnus tendon were also studied in our series. The origin, course, branches and distribution of the lateral superior genicular artery were observed on 40 adult cadaveric lower limbs perfused with latax. Twelve New Zealand adult rabbits were divided into two groups randomly. The Achilles tendon defects were reconstructed with vascularlized flexor digitorum longus tendon, the contralateral Achilles tendon served as a free tendon control. The histological observations and biochemical tests were made at 12 week postoperatively. Ten cases were operated (man 8, female 2). To bridge the gap of the ?? Achilles tendon, seven patients with older Achilles tendon defect were treated using the vascularized adductor magnus tendon by the end to end (or end to side) anastomoses of the descending genicular vessels to posterior tibial vessels. Three cases with composite Achilles tendon defects were reconstructed by the vascularized transfer of the adductor magnus tendon combine flaps. Results The descending genicular artery originated from the femoral artery in 95% of the cadavers at the site of 7.8 ?.8cm proximal to the tubercule of the adductor magnus. The descending gencular artery would give off the articular branch, saphenous artery and the muscular artery to the vastus medialis muscule in 90% of the cadavers. The caliber of the descending genicular artery and its articular branch which supplies the adductor magnus tendon and the cancellous bone of the medial condyle is 1.9?0.4 mm and 1.4 ?0.4 mm individually. The lateral superior genicular artery originated from the popliteal artery at the site 5.2 ?0.9 cm superior to head of the fibua. Its originated external diameter is 1.8 ?0.4. mm. It divided into ascending branch and descending branch after wandering 3.0?.2 cm. The originated external diameter of the ascending branch is 1.2 ?0.4 mm, and it gave off muscular branch, 3棐5 periosteal branches to femoral external condyle and perforating rami of iliotibial band. The lowest perforating rami of iliotibial band is 6.1 ?1.1 cm superior to head of fibula. In the experimental sides, the histological structure closed to the normal Achilles tendon and the transfer tendon regained 64.2% of the tensile strength of the normal Achilles tendon. The results of the control sides indicated that the tendon fibrin was wrapped by the scar tissue histologically, and that the tendon transfers regained 35.3% of the te...