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족배부 복합 피부-건 유리피판을 이용한 Achilles 건의 일단계 재건술

Other Titles
 One-Stage Achilles Tendon Reconstruction Using the Free Composite Dorsalis Pedis Flap in Complex Wound 
 김석원  ;  이원재  ;  서동완  ;  정윤규  ;  탁관철 
 Journal of the Korean Society for Microsurgery (대한미세수술학회지), Vol.9(2) : 114-119, 2000 
Journal Title
Journal of the Korean Society for Microsurgery(대한미세수술학회지)
Issue Date
Achilles tendon reconstruction ; Composite dorsalis pedis flap
The soft tissue defects including the Achilles tendon are complex and very difficult to reconstruct.
Recently, several free composite flaps including the tendon have been used to reconstruct large
defects in this area in an one-stage effort. Our case presents a patient reconstructed with free composite
dorsalis pedis flap along with the extensor digitorum longus and superficial peroneal nerve for
extensive defects of the Achilles tendon and surrounding soft tissue. A 36-year-old-man sustained an
open injury to the Achilles tendon. He was referred to our department with gross infection of the
wound and complete rupture of the tendon associated with loss of skin following reduction of distal
tibial bone fracture. After extensive debridement, 6×8㎝ of skin loss and 8㎝ of tendon defect was
noted. Corresponding to the size of the defect, the composite dorsalis pedis flap was raised as a neurosensory
unit including the extensor digitorum longus to provide tendon repair and sensate skin for
an one-stage reconstruction. One tendon slip was sutured to the soleus musculotendinous portion, the
other two were sutured to the gastrocnemius musculotendinous portion with 2-0 Prolene. The superficial
peroneal nerve was then coaptated to the medial sural cutaneous nerve. The anterior tibial
artery and vein were anastomosed to the posterior tibial artery and accompanying vein in an end to
end fashion. After 12 months of follow-up, 5 degrees of dorsiflexion due to the checkrein deformity
and 58 degrees of plantar flexion was achieved. The patient was able to walk without crutches. Twopoint
discrimination and moving two-point discrimination were more than 16㎜ at the transferred
flap site. The donor site healed uneventfully. Of the various free composite flaps for the Achilles tendon
reconstruction when skin coverage is also needed, we recommand the composite dorsalis pedis
flap. The advantages such as to control infection, adequate restoration of ankle contour for normal
foot wear, transfer of the long tendinous portion, and protective sensation makes this flap our first
choice for reconstruction of soft tissue defect including the Achilles tendon.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Won Jai(이원재) ORCID logo https://orcid.org/0000-0003-3056-0503
Tark, Kwan Chul(탁관철)
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