Predictors of Clinical Outcome after Reconstruction of Complex Soft Tissue Defects Involving the Achilles Tendon with the Composite Anterolateral Thigh Flap with Vascularized Fascia Lata

Jandali, Zaher; Lam, Martin C.; Merwart, Benedikt; Möhring, Bernd; Geil, S; Müller, Klaus Peter; Ionac, Mihai; Jiga, Lucian P.

doi:10.1055/s-0038-1660830

Cited by 13 publications

(23 citation statements)

References 30 publications

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“…41,42 However, ALT flap is also limited by demanding microsurgery, vascular crisis, and secondary thinning procedures for bulky flap. 43 The sural flap can be harvested easily without vascular anastomosis and has reliable blood supply without sacrificing the main vessel of leg.…”

Section: Discussionmentioning

confidence: 99%

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Zhou

Wei

Peng

et al. 2021

J Reconstr Microsurg

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Background This study is to describe the distribution of natural true anastomoses associated with the distally based perforator-plus sural neurocutaneous flap (sural flap), summarize our experience in the flap with high pivot point, and compare the outcomes between the flaps with high and low pivot points. Methods Five amputated lower limbs were perfused, and the integuments were radiographed. We retrospectively analyzed 378 flaps, which were divided into two groups: pivot points located ≤8.0 cm (low pivot point group) and >8.0 cm (high pivot point group) proximal to the tip of the lateral malleolus. Partial necrosis rates were compared between two groups. Results The arterial chain surrounding the sural nerve was linked by true anastomoses from the intermalleolar line to popliteal crease. True anastomoses existed among peroneal perforators and between these perforators and the arterial chain. There were 93 flaps with high pivot point and 285 flaps with low pivot point. Partial necrosis rates were 16 and 9.1% in the high and low pivot point group (p = 0.059), respectively. Conclusion True anastomosis connections among peroneal perforators and the whole arterial chain around sural nerve enable the sural flap to survive with a greater length. The sural flap with high pivot point is a good option for reconstructing soft-tissue defects in the middle and distal leg, ankle, and foot, particularly when the lowest peroneal perforator presents damage, greater distance to the defects, discontinuity with the donor site, or anatomical variation.

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Section: Discussionmentioning

confidence: 99%

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Zhou

Wei

Peng

et al. 2021

J Reconstr Microsurg

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“…29 The composite anterolateral thigh flap with the fascia lata has been widely applied in Achilles region, especially in massive deficit. [30][31][32] There are some unignorable drawbacks including vascular crisis, secondary thinning procedures for bulky flap and deficit of quadriceps femoris muscle contraction forces. 2,31 The radial forearm flap with palmaris longus tendon provides thin and pliable integument and long tendon, while it has significant donorsite morbidity and is better suited for small rather than massive defects.…”

Section: Discussionmentioning

confidence: 99%

“…[30][31][32] There are some unignorable drawbacks including vascular crisis, secondary thinning procedures for bulky flap and deficit of quadriceps femoris muscle contraction forces. 2,31 The radial forearm flap with palmaris longus tendon provides thin and pliable integument and long tendon, while it has significant donorsite morbidity and is better suited for small rather than massive defects. 33,34 Dobke et al 35 reported satisfactory outcomes of the extended temporoparietal fasciagaleal flap for a long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue

Zhou

Wei

Tao

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: Defect of Achilles tendon and overlying soft tissue remains a surgical challenge due to its insufficient blood supply and high requirement of function. This study aims to report the clinical efficacy of the composite sural neurocutaneous composite flap with gastrocnemius tendon on the complicated defect of Achilles region. Methods: Seven cases of defects of Achilles tendon and overlying soft tissue were reconstructed by the composite sural neurocutaneous composite flaps with gastrocnemius tendons. It is important to keep the connection between gastrocnemius tendon and deep fascia of the composite flap during operation. The smallest and the largest areas of transferred skin flaps were 7.5 cm × 4.5 cm and 11 cm × 10 cm respectively. The size of gastrocnemius tendon ranged from 5 cm × 3 cm to 9 cm × 4 cm. Patients was evaluated by using the Arner-Lindholm scale at the last follow-up. Results: Six flaps survived completely with no complication. One flap developed wound dehiscence and went on to heal by daily dressing. With 12–60 months follow-up, all patients gained satisfactory appearance and function of ankle, without tendon re-rupture or recurrent infection. Based on Arner-Lindholm scale, six cases were noted to be excellent and one was good. Conclusion: The composite sural neurocutaneous flap with gastrocnemius tendon is a viable and practical method to salvage Achilles tendon defect and overlying soft tissue coverage, with minimal adhesion and satisfactory function.

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“…The finding in this study that BMI did not affect outcomes is in disagreement with earlier studies. 16,23 Olsson et al 24 concluded that a high BMI predicted a worse ATRS at both 6 and 12 months, but no correlation was found with heel-rise height.…”

Section: Discussionmentioning

confidence: 99%

Older Age Predicts Worse Function 1 Year After an Acute Achilles Tendon Rupture: A Prognostic Multicenter Study on 391 Patients

Westin

Svedman

Senorski

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:There is limited evidence regarding the patient-related factors that influence treatment outcomes after an acute Achilles tendon rupture.Purpose/Hypothesis:The purpose of this study was to determine the predictors of functional and patient-reported outcomes 1 year after an acute Achilles tendon rupture using a multicenter cohort and to determine patient characteristics for reporting within the top and bottom 10% of the Achilles tendon Total Rupture Score (ATRS) and heel-rise height outcomes. The hypothesis was that older age, greater body mass index (BMI), and female sex would lead to inferior outcomes.Study Design:Cohort study; Level of evidence, 2.Methods:Patients were selected by combining 5 randomized controlled trials from 2 different centers in Sweden. Functional outcomes were assessed using validated heel-rise tests (height, number of repetitions, total work, and concentric power) for muscular endurance and strength, and the relationship between injured and uninjured legs was calculated as the limb symmetry index (LSI). Patient-reported outcomes were measured using the ATRS. All outcomes were collected at the 1-year follow-up. Independent predictors included were patient sex, smoking, BMI, age, and surgical versus nonsurgical treatment.Results:Of the 391 included patients, 307 (79%) were treated surgically. The LSI of heel-rise height at the 1-year follow-up decreased by approximately 4% for every 10-year increment in age (beta, –3.94 [95% CI, –6.19 to –1.69]; P = .0006). In addition, every 10-year increment in age resulted in a 1.79-fold increase in the odds of being in the lowest 10% of the LSI of heel-rise height. Moreover, a nonsignificant superior LSI of heel-rise height was found in patients treated surgically compared with nonsurgical treatment (beta, –4.49 [95% CI, –9.14 to 0.16]; P = .058). No significant predictor was related to the ATRS. Smoking, patient sex, and BMI did not significantly affect the 1-year results for the LSI of the heel-rise tests.Conclusion:Older age at the time of injury negatively affected heel-rise height 1 year after an Achilles tendon rupture. Irrespective of age, a nonsignificant relationship toward the superior recovery of heel-rise height was seen in patients treated surgically. None of the factors studied affected patient-reported outcomes.

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Predictors of Clinical Outcome after Reconstruction of Complex Soft Tissue Defects Involving the Achilles Tendon with the Composite Anterolateral Thigh Flap with Vascularized Fascia Lata

Cited by 13 publications

References 30 publications

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Distally Based Perforator-Plus Sural Neurocutaneous Flap with High or Low Pivot Point: Anatomical Considerations and a Retrospective Study of a Clinical Series of 378 Flaps

Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue

Older Age Predicts Worse Function 1 Year After an Acute Achilles Tendon Rupture: A Prognostic Multicenter Study on 391 Patients

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