A Flap Augmentation Technique for Achilles Tendon Repair

Medial Achilles tendon island flap—a novel technique to treat reruptures and neglected ruptures of the Achilles tendon

“…This is possibly true also for different types of flap augmentation. Gerdes et al [2] showed that flap augmentation produced better pull-out strength than end-to-end sutures alone but the increase in strength when adding more tissue to the rupture site needs to be balanced against the risk of wound problems, especially in patients with an obvious retraction of the skin over the rupture site. End-to-end sutures alone have been recommended if the resected tendon gap is less than 2.5 cm [11], and for V-Y tendon alignment there has been concern of tearing of the muscle during elongation when covering gaps greater than 4-5 cm [21].…”

“…Compared to acute ruptures [1], there is a strong consensus for surgical treatment of reruptures and neglected Achilles tendon ruptures. A number of different surgical techniques have been described including local tissue augmentation [2], free flaps [3] or turn-down flaps [4][5][6], tendon transfers [7], free tissue transfers or V-Y tendon alignment [8]. Since these late ruptures are fairly uncommon, only a small case series with limited follow-up of the results has been presented.…”

A Method for Combined Percutaneous and Open Surgical Repair of Achilles Tendon Ruptures: A Report of Three Cases

“…End-to-end repair, reinforced by a gastrocsoleus flap or tendon transfers proved to be superior to the other repairs in terms of biomechanical strength and rerupture risk. 4,5,7,9,11,21,23,24 Skin problems remain the most common and hazardous complication that may follow open Achilles tendon repairs. 1,2,6,11,14-2o, 25 Ma and Griffith's15 method of percutaneous repair reduced the major wound complications from 6% to 0%.18 Nevertheless, the rerupture rate increases from 1.5% to 12% after this procedure, which indicates that a need exists for bridging the repair by a flap or tendon.…”

Management of chronic Achilles tendon ruptures—A review

“…When used as an augmentation with end-to-end repair, the augmented tensile strength provided by a turn-down flap has been found to be 41% higher than that of the end-to-end repair alone. [55] Plantaris…”