Reconstruction of the Achilles Tendon and Overlying Soft Tissue by Free Composite Anterolateral Thigh Flap with Vascularized Fascia Lata

2012 ◽  
Vol 28 (03) ◽  
pp. 205-210 ◽  
Author(s):  
Philippe Houtmeyers ◽  
Dries Opsomer ◽  
Koenraad Van Landuyt ◽  
Stanislas Monstrey
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

Achilles Tendon Region Defects: Delayed Composite Anterolateral Thigh Flap With Stripping of Fascia Lata: A Case Series

2020 ◽  
Vol 66 (12) ◽  
pp. 13-22
Author(s):  
Cesare Tiengo ◽  
Regina Sonda ◽  
Andrea Monticelli ◽  
Francesco Messana ◽  
Alberto Crema ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Short Form ◽  
Case Series ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Reconstruction ◽  
Medical Outcomes ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction

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.

Single Stage Reconstruction of Posterior Soft Tissue Ankle Defects with a Free Anterolateral Thigh Flap and Rolled Tensor Fascia Lata for Functional Tendo-Achilles Reconstruction - A Case Report and Review of the Literature

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Bagirathan S ◽  
◽  
Ibrahim N ◽  
Patel NG ◽  
◽  
...  
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Fascia Lata ◽  
Single Stage ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Reconstruction ◽  
Tensor Fascia Lata ◽  
Anterolateral Thigh ◽  
Tissue Reconstruction ◽  
Sural Artery

Soft tissue defects in the posterior ankle region with underlying Achilles tendon loss pose a reconstructive challenge to both Orthopaedic and Plastic surgeons. Such injuries can result in a severely debilitating sequelae for the patient, therefore reconstruction of the area must provide reliable function and durability with minimal complications and aesthetically pleasing results to enable normal foot wear. We describe the case of a twenty-seven year old male, who presented following a traumatic open rupture of the Achilles tendon and failed reverse sural artery flap. We performed a single stage composite soft tissue reconstruction with a free anterolateral thigh (ALT) flap and rolled vascularised Tensor Fascia Lata (TFL) for functional Achilles tendon reconstruction. The patient had no post-operative complications and was able to fully weight bear and dorsiflex his foot beyond ninety degrees at seven month follow-up. Whilst many options are available to reconstruct this area, we review the literature to illustrate the advantages of using this technique to achieve all of the above factors, and advocate for all foot and ankle surgeons to be aware of its use in their reconstructive repertoire.

Predictors of Clinical Outcome after Reconstruction of Complex Soft Tissue Defects Involving the Achilles Tendon with the Composite Anterolateral Thigh Flap with Vascularized Fascia Lata

2018 ◽  
Vol 34 (08) ◽  
pp. 632-641 ◽  
Author(s):  
Zaher Jandali ◽  
Martin Lam ◽  
Benedikt Merwart ◽  
Bernd Möhring ◽  
Stephanie Geil ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Clinical Outcome ◽  
Achilles Tendon ◽  
Range Of Motion ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Mri Studies ◽  
Anterolateral Thigh ◽  
Tissue Defects

Background The composite anterolateral thigh flap with vascularized fascia lata (ALT-FL flap) for covering complex soft tissue defects involving the Achilles tendon has shown promising results. The age and body mass index (BMI) are important predictors of clinical outcome after surgical treatment of Achilles tendon ruptures. In this study, we investigate whether these also influence the outcome of patients after Achilles tendon reconstruction using the ALT-FL flap. Methods Twenty patients (mean age: 55.9 ± 8.7 years) with complex tissue defects involving the Achilles tendon underwent reconstruction with the ALT-FL flap. Both the Achilles tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed preoperatively and 12 months postoperatively. In addition, postoperative magnetic resonance imaging (MRI) studies and measurements of the ankle range of motion were performed and results compared with existing literature. Results All flaps survived and MRI studies confirmed complete anatomical integration of the fascia lata as “neotendon” at the recipient site. In our patient cohort, the age did not correlate with the outcome measurements, whereas the BMI showed significant negative correlation with the postoperative ATRS (p < 0.001) and AOFAS scores (p < 0.05). The ATRS and AOFAS scores of all patients improved significantly (p < 0.001). However, obese patients with a BMI of more than 30 kg/m2 achieved significant lower ATRS (p < 0.001) and AOFAS scores (p < 0.01), as well as patients with peripheral artery disease (PAD) (p < 0.05). The mean ankle range of motion after ALT-FL flap reconstruction remained statistical insignificant compared with previous avascular or vascularized tendon repairs of the Achilles tendon. Conclusion The ALT-FL flap enables reconstruction of complex tissue defects involving the Achilles tendon with good functional results. However, the presence of an increased BMI or PAD, but not necessarily the age, proves to be a predictor of poor clinical outcome and therefore should be subject to scrutiny during patient selection.

Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: Long term recovery and functional outcomes

Microsurgery ◽  
2019 ◽  
Vol 39 (5) ◽  
pp. 405-415 ◽  
Author(s):  
Pietro G. Summa ◽  
Gianluca Sapino ◽  
Mario Cherubino ◽  
Giorgio De Santis ◽  
Sebastien Durand ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcomes ◽  
Fascia Lata ◽  
Anterolateral Thigh Flap ◽  
Soft Tissue Defects ◽  
Anterolateral Thigh ◽  
Tissue Defects

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

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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