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

2013 ◽  
Vol 46 (01) ◽  
pp. 121-123 ◽  
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.

The Free Gracilis Muscle Flap in Achilles Tendon Coverage and Reconstruction

2012 ◽  
Vol 129 (4) ◽  
pp. 910-919 ◽  
Author(s):  
Georg M. Huemer ◽  
Lorenz Larcher ◽  
Thomas Schoeller ◽  
Thomas Bauer
Keyword(s):  
Achilles Tendon ◽  
Muscle Flap ◽  
Gracilis Muscle ◽  
Gracilis Muscle Flap ◽  
Tendon Coverage

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

2008 ◽  
Vol 14 (2) ◽  
pp. 96-99 ◽  
Author(s):  
P.R.J.V.C. Boopalan ◽  
Thilak S. Jepegnanam ◽  
V.T.K. Titus ◽  
Seetharam Y. Prasad ◽  
Samuel B. Chittaranjan
Keyword(s):  
Soft Tissue ◽  
Achilles Tendon ◽  
Reverse Flow ◽  
Tendon Injury ◽  
Fascia Lata ◽  
Sural Flap ◽  
Soft Tissue Cover ◽  
Fascia Lata Graft

scholarly journals Simultaneous debridement, Ilizarov reconstruction and free muscle flaps in the management of complex tibial infection

2020 ◽  
Vol 6 (3) ◽  
pp. 63-72
Author(s):  
Max Mifsud ◽  
Jamie Y. Ferguson ◽  
David A. Stubbs ◽  
Alex J. Ramsden ◽  
Martin A. McNally
Keyword(s):  
Muscle Flap ◽  
Tissue Loss ◽  
Bony Union ◽  
Ilizarov Method ◽  
Muscle Flaps ◽  
Flap Transfer ◽  
Non Union ◽  
Free Muscle Flap ◽  
Initial Surgery

Abstract. Chronic bone infections often present with complex bone and soft tissue loss. Management is difficult and commonly delivered in multiple stages over many months. This study investigated the feasibility and clinical outcomes of reconstruction in one stage. Fifty-seven consecutive patients with chronic osteomyelitis (n=27) or infected non-union (n=30) were treated with simultaneous debridement, Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was confirmed with strict criteria. 48 patients (84.2 %) had segmental defects. The primary outcome was eradication of infection at final follow-up. Secondary outcomes included bone union, flap survival and complications or re-operation related to the reconstruction. Infection was eradicated in 55∕57 cases (96.5 %) at a mean follow-up of 36 months (range 12–146). No flap failures occurred during distraction but 6 required early anastomotic revision and 3 were not salvageable (flap failure rate 5.3 %). Bony union was achieved in 52∕57 (91.2 %) with the initial surgery alone. After treatment of the five un-united docking sites, all cases achieved bony union at final follow-up. Simultaneous reconstruction with Ilizarov method and free tissue transfer is safe but requires careful planning and logistic considerations. The outcomes from this study are equivalent or better than those reported after staged surgery.

A comparison of skin and muscle for cortical revascularization

2000 ◽  
Vol 13 (03) ◽  
pp. 128-134 ◽  
Author(s):  
J. D. Fowler ◽  
G. G. Matte ◽  
G. H. Johnston ◽  
C. D. Porter
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Cortical Bone ◽  
Blood Supply ◽  
Muscle Blood Flow ◽  
Muscle Flap ◽  
Trapezius Muscle ◽  
Random Pattern ◽  
Bone Blood Flow ◽  
Muscle Flaps

SummaryThe purpose of this project was to compare the ability of skin and muscle to revascularize cortical bone segments in the canine distal limb. A model mimicking severe combined soft tissue and orthopaedic injury with bone devascularization involving the canine metatarsus was developed. Soft tissue defects were reconstructed with a reverse saphenous conduit flap or a free trapezius muscle flap. Cortical bone blood flow was determined by the radiolabeled microsphere method at 21 days post-reconstruction. In addition cortical porosity, the amount of fluorescent labelled intracortical new bone, and the maximum depth of periosteal new bone were determined. Significant differences were not detected between skin and muscle reconstructions for any of the measured parameters of cortical revascularization. The mean values for cortical bone blood flow were higher than expected from previous studies, and did not correlate with subjective assessments of adhesion quality between bone and reconstructive tissue onlay. The reverse saphenous conduit flap, and the free trapezius muscle flap, may respectively provide superior blood supply to underlying bone than local random pattern skin and local pedicled muscle. The reverse saphenous conduit flap has a robust and reliable vascular supply, unlike that to random pattern skin. The free transfer of muscle maintains a vigorous blood supply, and has shown improvements in blood flow over pedicled muscle. Blood flow to both tissue types may be favourably affected by the denervation associated with transfer, causing arteriolar vasodilation and reductions in vascular resistance. In this model, comparable revascularization of cortical bone at 21 days was seen beneath reverse saphenous conduit flaps and free trapezius muscle flaps. However, a role for endosteal revascularization cannot be excluded.Cortical revascularization by skin and muscle reconstruction was compared at 21 days in a canine metatarsal model. Significant differences in cortical bone blood flow were not detected

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