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

Abstract

Loss 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.

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

“…16 The most utilized scoring method was the American Orthopaedic Foot and Ankle Score (AOFAS) ( n = 6), followed by the Medical Outcomes Shortform-36 (SF-36) ( n = 3). In studies reporting both pre- and postoperative scores, the average improvement in scores was 90.6% in the visual analogue scale of pain, 27 57.6% in AOFAS, 21 27 28 29.4% in the Achilles tendon Total Rupture Score (ATRS), 21 and 6.7% in SF-36. 11 The average Lower Extremity Functional Score (LEFS) was 65.5 at the recipient site and 78 at the donor site.…”

“…Complications were likely due to the limited vascularity of the region and reduced mobility of the surrounding soft tissue. 27 These complications often resulted in the original tendon-only defect developing overlying soft tissue damage after the primary surgery, or the original combined tendon and soft tissue defects increasing in size by the time of secondary repair with the composite flap, thus rendering the tendon repair a complex surgical challenge. Given the complexity of tendon defects, an emphasis must also be placed on a multidisciplinary limb salvage approach to management.…”

Anterolateral Thigh and Vascularized-tensor Fascia Lata Flaps for Long-gap Achilles Tendon Reconstruction

“…1 In defects smaller than 5 cm, local soft tissue, such as V-Y advancement with transfer flexor hallucis longus, peroneus brevis, flexor digitorum longus, or a gastrocnemius fascial turndown flap, can be used for reconstruction, which yield satisfactory functional results. 7,8 For long-gap Achilles tendon defects without overlying skin defects, some authors have proposed Achilles tendon allograft 3,6 or autograft, 9 hamstring tendon autograft, 4 distant tissue such as tensor fasciae latae, [10][11][12][13][14][15] or skin-aponeurosis-bone composite tissue from the groin region. 16 In post-traumatic injuries that involve defects in both the Achilles tendon and overlying skin, both strong tissues for Achilles tendon reconstruction and well-vascularized Winaikosol and Surakunprapha • Achilles Reconstruction with ALT and TFL tissue to healing and combat infection are required.…”

“…1 In defects smaller than 5 cm, local soft tissue, such as V-Y advancement with transfer flexor hallucis longus, peroneus brevis, flexor digitorum longus, or a gastrocnemius fascial turndown flap, can be used for reconstruction, which yield satisfactory functional results. 7,8 For long-gap Achilles tendon defects without overlying skin defects, some authors have proposed Achilles tendon allograft 3,6 or autograft, 9 hamstring tendon autograft, 4 distant tissue such as tensor fasciae latae, 10–15 or skin-aponeurosis-bone composite tissue from the groin region. 16…”

Rekonstruktionen von Weichteildefekten der Achillessehnen region – eine Literaturübersicht

“…Als Modifikationen sind ein ALT-Lappen mit einem Streifen des Tractus iliotibialis und Anteilen des M. vastus lateralis 64 oder eine chimäre Lappenplastik mit Tensor fasciae latae (TFL) Muskel und ALT-Lappen beschrieben, wobei der TFL zur Sehnen- und der ALT- Lappen zur Hautweichteilrekonstruktion verwendet wurden 65 . Weiterhin wurden Rekonstruktionen der Sehne durch einen umge- schlagenen Gastrosoleus-Lappen mit umhüllender vaskularisierter Fascia lata und Hautverschluss mit dem ALT-Lappen erzielt, was zur Ausheilung führte 66 . In einem Fallbericht wurde sogar ein am proximalen Achillessehnenstumpf entnommenes vaskularisiertes Sehnentransplantat, welches zwei Perforatoren enthielt, zur Rekon- struktion der Achillessehne genutzt, bevor die ALT-Lappenplastik zur Hautweichteilrekonstruktion erfolgte 67 .…”