Reconstruction of Combined Defects of the Achilles Tendon and the Overlying Soft Tissue With a Fascia Lata Graft and a Free Fasciocutaneous Lateral Arm 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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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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One-Stage Reconstruction of Soft Tissue and Achilles Tendon Defects Using a Composite Free Anterolateral Thigh Flap With Vascularized Fascia Lata: Clinical Experience and Functional Assessment

Annals of Plastic Surgery ◽

10.1097/01.sap.0000037270.95257.b9 ◽

2003 ◽

Vol 50 (2) ◽

pp. 149-155 ◽

Cited By ~ 73

Author(s):

Yur-Ren Kuo ◽

Mei-Hui Kuo ◽

Wen-Chieh Chou ◽

Yi-Tien Liu ◽

Barbara S. Lutz ◽

...

Keyword(s):

Soft Tissue ◽

Achilles Tendon ◽

Clinical Experience ◽

Functional Assessment ◽

Fascia Lata ◽

Anterolateral Thigh Flap ◽

One Stage ◽

Anterolateral Thigh ◽

One Stage Reconstruction ◽

Achilles Tendon Defects

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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

Foot & Ankle: Studies ◽

10.26420/footanklestud.2021.1024 ◽

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.

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