Open infected Achilles tendon injury—Reconstruction of tendon with fascia lata graft and soft tissue cover with a reverse flow sural flap

Defects of the Achilles tendon that include the surrounding soft tissue represent a challenge due to complex functionality and biomechanics. PURPOSE: The purpose of this study was to evaluate the functional and physical functioning score outcomes of patients following microsurgical reconstruction of the yarrow region, using a combination of objective, subjective, and semi-subjective measurements. METHODS: Between 2007 and 2018, 15 patients underwent delayed Achilles tendon region reconstruction with different anterolateral thigh flap types. Seven (7) patients underwent tendon and soft tissue reconstruction with a chimeric anterolateral thigh flap (ALT) and rolled-up fascia lata, and 8 patients underwent soft tissue reconstruction and only tendon coverage with fascia lata. Follow-up assessments included maximal range of motion (MROM) (plantarflexion and dorsiflexion), the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale score, and the Medical Outcomes Study 36-item Short-Form Health Survey physical functioning subscore. RESULTS: A total of 15 patients (11 males and 4 females with a mean age of 39.86 years) were evaluated during a mean follow-up time of 23 months (SD = 7.12). The MROM for plantarflexion and dorsiflexion was 42.71 degrees (SD = 2.9) and 24.8 degrees (SD = 4.29), respectively, in patients who underwent composite ALT with a rolled-up fascia lata. The MROM for plantarflexion and dorsiflexion was 43 degrees (SD = 5.37) and 27.37 degrees (SD = 3.2), respectively, in patients who underwent fasciocutaneous ALT. The mean American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale score was 82 for the first group and 86.87 for the second, whereas the mean Medical Outcomes Study 36-item Short-Form Health Survey scores were 82.57 and 81.5, respectively, for the 2 groups. Statistical analysis showed no significant difference between the 2 groups. CONCLUSIONS: The results of this case series suggest that the single-stage composite reconstruction with a fasciocutaneous flap with or without a strip of fascia lata is a safe and reliable strategy for composite reconstruction of the Achilles tendon region. Additional studies to evaluate these outcomes and instruments to evaluate functioning are necessary.

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Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata

JBJS Essential Surgical Techniques ◽

10.2106/jbjs.st.k.00001 ◽

2011 ◽

Vol 1 (2) ◽

pp. e8

Author(s):

Patrick Duhamel ◽

Sébastien Fossat ◽

Michel Brachet ◽

Laurent Mathieu ◽

Sylvain Rigal ◽

...

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Free Flap ◽

Fascia Lata ◽

Soft Tissue Defects ◽

Simultaneous Reconstruction ◽

Anterolateral Thigh ◽

Tissue Defects

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Reconstruction of segmental defects of Achilles tendon: Is it a must in infected complex defects?

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.113729 ◽

2013 ◽

Vol 46 (01) ◽

pp. 121-123 ◽

Cited By ~ 3

Author(s):

S. Raja Sabapathy ◽

Hari Venkataramani ◽

Latheesh Latheef ◽

Praveen Bhardwaj

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Muscle Flap ◽

Tendon Graft ◽

Tendon Injury ◽

Soft Tissue Defect ◽

Tissue Loss ◽

Muscle Flaps ◽

Gracilis Muscle Flap ◽

Soft Tissue Flap

ABSTRACTLoss of Achilles tendon combined with overlying soft tissue loss is a challenging problem. Multiple techniques like tendon graft with coverage by soft tissue flap or composite flaps have been used. All these options are technically demanding. Reports do exist whereby muscle flaps bridging the defect used as cover in course of time could transmit the tendon force across the defect. We are presenting a case where a free gracilis muscle flap used to cover the soft tissue defect at the Achilles tendon at 2 years follow up provided stable cover and produced active function of the Achilles tendon allowing the patient to stand tip toe. Mechanism of its action has been analysed by MRI and M-mode ultrasound. While in primary Achilles tendon injury reconstruction is still the recommended option, in complex situations mere filling of the gap with the flap without formal reconstruction of the tendon could give good functional outcome. This technique can be used in demanding situations.

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Soft tissue reconstruction with reverse flow sural flap in pilon fractures

SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital ◽

10.5350/semb.20170328044424 ◽

2017 ◽

pp. 102-8

Author(s):

Selami Serhat Şirvan ◽

Kamuran Zeynep Sevim ◽

Mehmet Mesut Sönmez ◽

Işıl Akgün Demir ◽

Dağhan Dağdelen ◽

...

Keyword(s):

Soft Tissue ◽

Reverse Flow ◽

Soft Tissue Reconstruction ◽

Sural Flap ◽

Tissue Reconstruction ◽

Pilon Fractures

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Achilles tendon Z-plasty with rollover tensor fascia lata graft for correction of equinus foot deformity

International Surgery Journal ◽

10.18203/2349-2902.isj20212298 ◽

2021 ◽

Vol 8 (6) ◽

pp. 1938

Author(s):

Madhusoodan Gupta ◽

Ankur Goel ◽

Deepti Varshney ◽

Vishal K. Biswkarma

Keyword(s):

Achilles Tendon ◽

Ankle Joint ◽

Full Range ◽

Fascia Lata ◽

Tensor Fascia Lata ◽

Fascia Lata Graft ◽

Post Traumatic ◽

Equinus Deformity ◽

The Right ◽

Sliding Technique

Equinus deformity is a condition in which dorsiflexion movement of the ankle joint is limited or decreased. Equinus deformity arises due to contracture/shortening/tightening in achilles tendon or soleus muscles or gastrocnemius muscle. The lengthening procedure of the achilles tendon can be done by various techniques such as the open or percutaneous method and Z-plasty versus sliding technique. Here we reported a case of post-traumatic equinus deformity of the right foot. The patient’s dorsiflexion movement was restricted. In this case, the patient was operated for open Z-plasty of the achilles tendon with rollover tensor fascia lata graft for lengthening of the contracted achilles tendon. The patient was discharged on the third postoperative day uneventfully. After 7 months of follow-up, the patient was walking normally without limping with the full range of motion at the right ankle joint as similar to his left ankle joint.

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Double-Layer Reconstruction of the Achilles’ Tendon Using a Modified Lindholm's Technique and Vascularized Fascia Lata

Journal of Hand and Microsurgery ◽

10.1055/s-0037-1608745 ◽

2017 ◽

Vol 10 (01) ◽

pp. 049-051

Author(s):

Osman Kelahmetoglu ◽

Mustafa Gules ◽

Nuh Elmadag ◽

Ethem Guneren ◽

Selma Sonmez Ergun

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Fascia Lata ◽

Soft Tissue Defects ◽

Anterolateral Thigh ◽

Wound Healing Problems ◽

Alt Flap ◽

Tissue Defects

AbstractLoss of the Achilles’ tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles’ tendon. A 37-year-old man suffered from tertiary Achilles’ tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles’ tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects. The patient was followed up for 12 months. No wound healing problems were reported, and the patient was able to walk and return to his daily ambulating activities without any support after 5 months postoperatively. This technique may be useful to achieve satisfactory outcomes in patients with ruptured Achilles’ tendons following tertiary repair.

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