Reconstruction of the Achilles Tendon and Overlying Skin Defect

Abstract

Although various reconstruction surgery techniques are available to repair posterior heel defects, the compound defects reconstruction is an ongoing surgical challenge. Complex, free tissue flaps are often clinically used in this repair operation but the techniques have some disadvantages, including intraoperative tedious dissections, vascular anastomosis, and postoperative thrombogenesis. Here, we present a single-stage procedure for Achilles tendon and its overlying skin defects repair with a complex posterior tibial artery perforator-based tissue flap on 3 patients. This method can repair the Achilles tendon and the soft tissue defects simultaneously in a relatively short operative time. The prognosis of the 3 operative patients described here was great for participating in exercise and daily work unassisted 18 to 26 months after operation. Clinical results indicate that our operative method can be effective in repair of Achilles tendon and its overlying skin defects without major complications.

Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis

“…Five out of six patients needed a small size split thickness skin graft at the donor site after a mean time of 7.1 days (range 7-9) of vacuum therapy to improve the granulation tissue and reduce the cosmetic impact on the forearm. DASH score values relating to the donor extremity resulted with a mean value of 8.0 points (range [3][4][5][6][7][8][9][10][11][12][13][14][15] with no significant functional impairment complained by patients. The MRI study at 8 months FU showed a nearly normal shape of the reconstructed tendon without interruptions, and the fusion between the two segments of FCR reaching in size the original Achilles tendon (Fig.…”

“…A composite vascularized flap, able to provide healthy tissues to simultaneously reconstruct both tendon and skin, may be a logical alternative. Several donor sites able to offer vascularized skin and tendon are available, and different flaps have been addressed in literature …”

“…Several donor sites able to offer vascularized skin and tendon are available, and different flaps have been addressed in literature. [6][7][8][9][10][11][12][13][14][15][16][17] The advent of propeller flaps and their reliability increased the value of pedicled flaps in the coverage of Achilles tendon region, providing healthy local skin to reconstruct an anatomical area, which very few, if any, conventional fasciocutaneous or muscle flaps were able to cover. However, in some cases, the perforators are not reliable and the quality of the skin may be affected by local factors such as edema, infection, and vascular diseases.…”

“…Tendinous allografts and autologous non‐vascularized tendon graft may be an alternative, but with some concerns in treating an infected complex defect by means of non‐vascularized tissues. Several authors have recently reported the use of pedicled and free flaps as a solution for a multilayer reconstruction associated with good clinical outcomes . Among them, Stamate et al in 1998, and then Coşkunol et al in 2005 reported their experience respectively in two and one case using a free radial forearm flap augmented with a vascularized tendon of Flexor Carpi Radialis (FCR) muscle.…”

“…Several authors have recently reported the use of pedicled and free flaps as a solution for a multilayer reconstruction associated with good clinical outcomes. [6][7][8][9][10][11][12][13][14][15][16][17] Among them, Stamate et al 16 in 1998, and then Coşkunol et al 17 in 2005 reported their experience respectively in two and one case using a free radial forearm flap augmented with a vascularized tendon of Flexor Carpi Radialis (FCR) muscle.…”