CHARACTERISTICS AND TREATMENT OF GRADE Ⅲ SPOKE HEEL INJURIES IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HEXiaoqing , ZHUYueliang ,  XUYongqing , WANGYi , MEILiangbin , LIYang

Institute of Trauma Orthopedic Surgery of Chinese PLA, Kunming General Hospital of Chengdu Military Region, Kunming Yunnan, 650032, P. R. China;

Corresponding author：

XUYongqing, Email: xuyongqingkm@163.net

Keywords：

Heel; Spoke injury; Achilles tendon repair; Children

DOI：

10.7507/1002-1892.20140322

Video：

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Objective To evaluate the characteristics, treatment, and effectiveness of grade Ⅲ spoke heel injury in children. Methods Between January 2007 and June 2013, 31 children with grade Ⅲ spoke heel injuries were treated. There were 19 boys and 12 girls, aged from 3 to 12 years (mean, 5.2 years). The time from trauma to operation was 2 hours to 26 days (mean, 4.4 days). The soft tissue defects of the heels ranged from 3.5 cm×2.5 cm to 8.0 cm×4.5 cm, which all complicated with Achilles tendon and calcaneus tuberosity defects. In 16 cases of large Achilles tendon defects which can not be stretched straightly to calcaneus tuberosities, repair with sl iding gastrocnemius musculocutaneous flaps (16 cm×5 cm to 21 cm×10 cm ) and insertion reconstruction of the tendon were performed. In 15 cases of Achilles tendon defects which can be stretched straightly to calcaneus tuberosities, repair with reversed pedicled flap (4.0 cm×2.5 cm to 8.0 cm×4.5 cm) and insertion reconstruction of the tendon were given. Nerve anastomosis was not performed. The donor site was covered with spl it-thickness skin graft. Results All children were followed up 6 months to 4 years (mean, 13 months). The other flaps survived except 3 cases having partial necrosis. The color and appearance of the flaps were satisfactory, with no impact on wearing shoes and walking. The flaps recovered sensory function. As more follow-up time, the angle of dorsal flexion was gradually improved. Heel raising on one leg was restored. The bone amount of calcaneus tuberosity increased slowly based on X-ray films. Conclusion Grade Ⅲ spoke heel injury in children possesses pecul iar features, surgical methods should be based on defects of Achilles tendon and soft tissue. Dorsal flexion of the ankle is obviously l imited; as follow-up time goes on, the ankle function is progressively improved. However, long-term follow-up is needed.

Citation： HEXiaoqing, ZHUYueliang, XUYongqing, WANGYi, MEILiangbin, LIYang. CHARACTERISTICS AND TREATMENT OF GRADE Ⅲ SPOKE HEEL INJURIES IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(12): 1490-1493. doi: 10.7507/1002-1892.20140322 Copy

1.	朱跃良, 徐永清, 李军, 等. 儿童足后跟轮辐伤的临床治疗. 中国修复重建外科杂志, 2009, 23(10):1180-1182.
2.	徐向阳, 周炎, 瞿新丛. 腓肠神经营养血管皮瓣逆行修复儿童跟腱部轮辐伤. 创伤外科杂志, 2013, 15(2):133-135.
3.	Zhu YL, Li J, Ma WQ, et al. Motorcycle spoke injuries of the heel. Injury, 2011, 42(4):356-361.
4.	徐永清, 杨军, 朱跃良, 等. 双蒂腓肠肌皮瓣修复跟腱及皮肤缺损的解剖学研究及临床应用. 中华创伤骨科杂志, 2006, 8(12):1132-1134.
5.	杨太明, 孔祥如, 高先亭, 等. 推进腓肠肌皮瓣修复跟腱开放性缺损. 中国修复重建外科杂志, 2011, 25(12):1519-1520.
6.	姚俊娜, 赵祚塨, 杜志军, 等. 胫后动脉穿支皮瓣在足跟部软组织缺损修复中的应用. 中华显微外科杂志, 2014, 37(2):176-178.
7.	李振, 李忠, 刘雪涛, 等. 胫后动脉内踝上穿支皮瓣修复跟腱部皮肤软组织缺损. 中国骨与关节损伤杂志, 2013, 28(2):182-183.
8.	吴必华, 魏在荣, 唐修俊, 等. 胫后动脉穿支蒂混合供血皮瓣修复儿童小腿创面. 中华小儿外科杂志, 2013, 34(5):349-352.
9.	肖峰, 肖宏, 郭筱秋. 带腓肠神经营养血管逆行岛状皮瓣修复足跟部皮肤软组织缺损. 中国修复重建外科杂志, 2009, 23(2):253-254.
10.	贾晓川, 刘振武, 刘利, 等. 改良腓肠神经营养血管皮瓣修复足跟部缺损26例. 实用手外科杂志, 2014, 28(1):86-87.
11.	董忠根, 杨颖, 魏建伟, 等. 腓动脉穿支筋膜蒂腓肠筋膜皮瓣联合腓骨短肌腱转位同期修复跟腱并皮肤缺损. 中华创伤骨科杂志, 2013, 15(12):1093-1095.
12.	胡长青, 王顺义, 马战备, 等. 儿童足跟部严重损伤的骨及软组织修复. 中华小儿外科杂志, 2013, 34(5):366-368.
13.	俞光荣, 赵宏谋, 袁锋, 等. 儿童跟骨关节内骨折的分型特征及手术治疗. 中华骨科杂志, 2011, 31(12):1319-1324.
14.	Zhu YL, Xu YQ, Yang J, et al. One-stage reconstruction of Achilles tendon and skin defects by the sliding gastrocnemius musculocutaneous flap without anastomosis. J Trauma, 2009, 66(4):1129-1134.
15.	于铁强, 左玉明, 王月光, 等. 封闭式负压引流技术联合腓肠神经营养血管皮瓣修复儿童足跟部软组织缺损. 中国修复重建外科杂志, 2013, 27(5):637-638.
16.	Lynn T. Stahel i. 实用小儿骨科学. 潘少川, 主译. 北京:人民卫生出版社, 2008:4-6.

1. 朱跃良, 徐永清, 李军, 等. 儿童足后跟轮辐伤的临床治疗. 中国修复重建外科杂志, 2009, 23(10):1180-1182.
2. 徐向阳, 周炎, 瞿新丛. 腓肠神经营养血管皮瓣逆行修复儿童跟腱部轮辐伤. 创伤外科杂志, 2013, 15(2):133-135.
3. Zhu YL, Li J, Ma WQ, et al. Motorcycle spoke injuries of the heel. Injury, 2011, 42(4):356-361.
4. 徐永清, 杨军, 朱跃良, 等. 双蒂腓肠肌皮瓣修复跟腱及皮肤缺损的解剖学研究及临床应用. 中华创伤骨科杂志, 2006, 8(12):1132-1134.
5. 杨太明, 孔祥如, 高先亭, 等. 推进腓肠肌皮瓣修复跟腱开放性缺损. 中国修复重建外科杂志, 2011, 25(12):1519-1520.
6. 姚俊娜, 赵祚塨, 杜志军, 等. 胫后动脉穿支皮瓣在足跟部软组织缺损修复中的应用. 中华显微外科杂志, 2014, 37(2):176-178.
7. 李振, 李忠, 刘雪涛, 等. 胫后动脉内踝上穿支皮瓣修复跟腱部皮肤软组织缺损. 中国骨与关节损伤杂志, 2013, 28(2):182-183.
8. 吴必华, 魏在荣, 唐修俊, 等. 胫后动脉穿支蒂混合供血皮瓣修复儿童小腿创面. 中华小儿外科杂志, 2013, 34(5):349-352.
9. 肖峰, 肖宏, 郭筱秋. 带腓肠神经营养血管逆行岛状皮瓣修复足跟部皮肤软组织缺损. 中国修复重建外科杂志, 2009, 23(2):253-254.
10. 贾晓川, 刘振武, 刘利, 等. 改良腓肠神经营养血管皮瓣修复足跟部缺损26例. 实用手外科杂志, 2014, 28(1):86-87.
11. 董忠根, 杨颖, 魏建伟, 等. 腓动脉穿支筋膜蒂腓肠筋膜皮瓣联合腓骨短肌腱转位同期修复跟腱并皮肤缺损. 中华创伤骨科杂志, 2013, 15(12):1093-1095.
12. 胡长青, 王顺义, 马战备, 等. 儿童足跟部严重损伤的骨及软组织修复. 中华小儿外科杂志, 2013, 34(5):366-368.
13. 俞光荣, 赵宏谋, 袁锋, 等. 儿童跟骨关节内骨折的分型特征及手术治疗. 中华骨科杂志, 2011, 31(12):1319-1324.
14. Zhu YL, Xu YQ, Yang J, et al. One-stage reconstruction of Achilles tendon and skin defects by the sliding gastrocnemius musculocutaneous flap without anastomosis. J Trauma, 2009, 66(4):1129-1134.
15. 于铁强, 左玉明, 王月光, 等. 封闭式负压引流技术联合腓肠神经营养血管皮瓣修复儿童足跟部软组织缺损. 中国修复重建外科杂志, 2013, 27(5):637-638.
16. Lynn T. Stahel i. 实用小儿骨科学. 潘少川, 主译. 北京:人民卫生出版社, 2008:4-6.

Chinese Journal of Reparative and Reconstructive Surgery

CHARACTERISTICS AND TREATMENT OF GRADE Ⅲ SPOKE HEEL INJURIES IN CHILDREN

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