Rekonstruktionen von Weichteildefekten der Achillessehnen region – eine Literaturübersicht

Zusammenfassung

Hintergrund Weichteildefekte der Regio tendinis achilleae treten nach Traumata und insbesondere als Komplikation nach offener Rekonstruktion der Sehne mit nachfolgendem Infekt auf.

Ziel der Arbeit Es werden Empfehlungen zur Therapie von Weichteilverletzungen mit Beteiligung der Achillessehne im Kontext der Literatur formuliert.

Material und Methoden Es wurde eine Recherche der deutsch-, französisch- und englischsprachigen Literatur zur Rekonstruktion von Hautweichteildefekten der Achillessehnenregion durchgeführt, welche in singuläre und kombinierte tendokutane Defekte differenziert wurden. Kombinierte Defekte wurden basierend auf drei rekonstruktiven Prinzipien weiter untergliedert in: ein alleiniger Verschluss der Haut ohne Sehnenrekonstruktion sowie eine Rekonstruktion der Haut zusammen mit einer Sehnenrekonstruktion als vaskularisiertes oder avaskuläres Transplantat.

Ergebnisse Lokale und distal gestielte Lappenplastiken sind für die Rekonstruktion über der Achillessehne mit einer hohen lokalen Morbidität behaftet, weshalb die Autoren freie Lappenplastiken aufgrund der geringeren Komplikationsrate favorisieren. Hier eignet sich für kleine Defekte die freie Medial Sural Artery (MSAP-)Lappenplastik, bei großen Defekten Muskeloder fasziokutane Lappenplastiken. Technik der Wahl für die kombinierte tendokutane Rekonstruktion ist die ALTLappenplastik mit vaskularisierter Fascia lata. Als nicht vaskuläre Sehnentransplantate werden häufig die Sehne des M. flexor hallucis longus oder des M. peroneus brevis verwendet.

Fazit Die Rekonstruktion der Achillessehnenregion erfordert dünne strapazier- und gleitfähige Lappen, die eine Schuhver- sorgung ermöglichen. Die postoperative Kraft und Beweglichkeit des Sprunggelenkes zeigen vergleichbare funktionelle Resultate nach vaskularisierter und nicht vaskularisierter Seh- nenrekonstruktion.

Abstract

Background Soft tissue defects in the achilles tendon region occur after trauma, but also as a complication after open recon- struction of the tendon with subsequent infection.

Objectives Recommendations for the treatment of soft tissue injuries involving the Achilles tendon are presented.

Materials and Methods A search of the German, French and English literature on reconstruction of soft tissue defects of the Achilles tendon region was performed, which were differentiated into singular and combined tendocutaneous defects. Combined defects were further subdivided into three reconstructive principles: a simple soft tissue reconstruction without tendon repair or a combined reconstruction of the soft tissue as well as the tendon using either a vascularized tendon transplant or an avascular tendon graft.

Results Local and distally-based pedicled flaps include a relatively high risk or perioperative morbidity, whereas free flaps are described with significantly lower complications rates. Therefore, the authors prefer free flaps for reconstruction. Potential donor sites are the Medial Sural Artery (MSAP-) flap for smaller defects or free fasciocutaneous or muscle flaps in patients with large defects. The standard for tendocutaneousreconstructions is the free anterolateral thigh flap including vascularized fascia. Non-vascularized tendon grafts are frequently applied from the flexor hallucis longus- or peroneus brevis tendon.

Conclusions Reconstructions over the Achilles tendon require thin and stable reconstructions that additionally allow slippage of soft tissues. Moreover, the use of normal shoes should be possible. The postoperative strength and range of motion of the ankle joint show comparable functional results after vascularized and non-vascularized tendon reconstruction.

Schlüsselwörter

Achillessehne - freie Lappenplastik - Fuß - Rekonstruktion - Weichteilverletzung;

Key words

achilles tendon - foot - free flap - reconstruction - soft tissue injury

Publikationsverlauf

Eingereicht: 04. Juni 2021

Angenommen: 03. März 2022

Artikel online veröffentlicht:
22. Juni 2022

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