[Curative effect analysis of skin flap and allogeneic tendon in reconstructing limbs function of complex soft-tissue...

To investigate the curative effect of skin flap and allogenic tendon in reconstructing limbs function of complex soft-tissue defect.

From May 2001 to December 2007, 43 cases of complex soft-tissue defect of limbs were repaired by pedicled skin flaps, free skin flaps, cutaneous nerve nutrient vessel skin flaps and arterial island skin flaps for primary stage, then the function of the limbs were reconstructed with allogeneic tendon after 2-3 months of skin flap operation. There were 31 males and 12 females, aged 5-53 years (mean 25 years). Injury was caused by machine in 28 cases, by traffic accident in 14 cases and others in 1 case. There were 27 cases in upper limb, 16 cases in lower limb. Twenty-six cases complicated by bone fracture, dislocation and bone defect, the most of bone defect were cortical bone defect. The sizes of skin and parenchyma defect were 9 cm x 4 cm to 37 cm x 11 cm, the length of tendon defect was 6 to 26 cm. The sizes of skin flaps were 10 cm x 5 cm to 39 cm x 12 cm. Allogeneic tendons were used 2-6 strips (mean 4 strips).

Forty-three cases were followed up for 5-56 months (16 months on average), all flaps survived. The donor area healed by first intention, the incision healed by first intention in second operation, and no tendon rejection occurred. The clinical healing time of fracture was 3-8 months, and the clinical healing time of allograft was 6-8 months. Six cases were given tenolysis for adhesion of tendon after 3-5 months of tendon transplantation. The postoperative flexion of wrist joint was 20-50 degrees, the extension was 20-45 degrees. Articulation metacarpophalangeal and articulation interphalangeal could extend completely. The flexion of articulation metacarpophalangeal of thumb was 20-45 degrees, the flexion of articulation interphalangeal was 30-70 degrees. The flexion of articulation metacarpophalangeal and articulation interphalangeal of the other fingers was 60-90 degrees. The postoperative ankle can extend to neutral position, the neutral position of ankle was 30-50 degrees. The flexion of articulation metatarsophalangeal and articulation interdigital was 20-40 degrees. The extension of articulation metatarsophalangeal was 30-60 degrees.

Through designing systematically treatment plan, practicing operation by stages, preventing adhesion of tendon actively and exercising function reasonably, the functions of limbs reconstructed by allogenic tendon and skin flap can leads to satisfactory effect.