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首页> 外文期刊>Plastic and reconstructive surgery >Outcome of skin graft versus flap surgery in the salvage of the exposed achilles tendon in diabetics versus nondiabetics.
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Outcome of skin graft versus flap surgery in the salvage of the exposed achilles tendon in diabetics versus nondiabetics.

机译：糖尿病患者和非糖尿病患者在暴露的跟腱修复中皮瓣移植与皮瓣移植的结果。

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BACKGROUND: Achilles tendon wounds pose a reconstructive dilemma because of the tendon's functional importance and the paucity of soft tissue surrounding the ankle. The currently accepted treatment is to repair the wound with a flap (local, pedicled, or free). In this article, the authors examine whether skin graft coverage of the exposed Achilles tendon is a viable option for reconstruction and whether the comorbidity of diabetes affects the outcome. METHODS: Forty-five consecutive patients presenting with wounds involving the Achilles tendon in 49 limbs were retrospectively evaluated from the authors' limb salvage registry from 1990 to 1999. RESULTS: After initial debridement, the method of reconstruction consisted of closure by secondary intention (n = 6), skin grafting (n = 27), and reconstruction with a flap (n = 10) or free flaps (n 6). The primary success rate of each procedure was not significantly different: secondary intention, 83 percent; skin graft, 83 percent; local flap, 80 percent; and free flap, 83 percent. The overall wound-healing rate was 96 percent and the limb salvage rate was 98 percent. Six wounds eventually recurred in patients who had undergone skin grafting. All but one went on to heal with conservative therapy. There was no difference in any of the result parameters between diabetics and nondiabetics. CONCLUSIONS: This study demonstrates that, with a properly prepared wound bed, skin grafting can be as effective as local or free flaps in successfully healing Achilles tendon wounds. Diabetes should not be used as a contraindication to limb salvage in patients who present with Achilles tendon ulceration or gangrene.
机译：背景：跟腱损伤造成了重建难题，因为腱的功能重要性以及脚踝周围软组织的缺乏。目前公认的治疗方法是用皮瓣（局部，带蒂或游离的）修复伤口。在本文中，作者检查了暴露的跟腱的皮肤移植物覆盖是否是重建的可行选择，以及糖尿病的合并症是否影响预后。方法：回顾性分析1990年至1999年间作者的肢体抢救记录，对49例肢体中涉及跟腱损伤的45例连续患者进行回顾性评估。 = 6），植皮（n = 27）和皮瓣重建（n = 10）或游离皮瓣重建（n 6）。每种手术的主要成功率没有显着差异：次要​​目的为83％;植皮83％;局部皮瓣，百分之八十;和自由襟翼，占83％。总体伤口愈合率为96％，肢体抢救率为98％。接受皮肤移植的患者最终再次出现六处伤口。除一个人外，其余所有人均通过保守疗法治愈。糖尿病患者和非糖尿病患者的任何结果参数均无差异。结论：这项研究表明，在适当准备伤口床的情况下，植皮与局部或游离皮瓣在成功治愈跟腱损伤方面一样有效。患有跟腱断裂或坏疽的患者，不应将糖尿病用作肢体抢救的禁忌证。

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