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

Abstract

Background: Wound dehiscence, infection, and necrosis of tendon and overlying skin are severe complications after open repairs of Achilles tendon. A simultaneous reconstruction should be provided in a single stage operation. We evaluated the outcomes of one of the possible options: the radial forearm free flap with Flexor Carpi Radialis (FCR) tendon. Methods: Between 2006 and 2014, six patients affected by infection and necrosis after Achilles tendon open repair underwent multi-tissutal reconstruction by a composite radial forearm free flap including a vascularized FCR tendon. The mean skin and tendon defect was respectively 9.8 cm 3 4.7 cm and 6.5 cm. After reconstruction, patients underwent clinical examination, including the Achilles Tendon Total Rupture Score (ATRS) questionnaire, DASH score, MRI study, and a computer-assisted gait analysis. Results: All flaps survived and no complications were recorded. Full weightbearing was allowed within 2 months after surgery. The mean follow-up was 36.2 months (range 12-96). MRI showed an optimal reconstruction of the tendon. Range of motion was minimally reduced if compared to the contralateral side. Gait analysis showed the recovery of a nearly symmetrical stance phase, time to heel off, and step length of the gate. ATRS and DASH score improved to a mean value of 85.2 (range 83-88) and 8.0 (range 3-15) respectively. Conclusions: This procedure provided an anatomical reconstruction of the Achilles tendon and skin achieving good and objective functional results; donor site morbidity was limited to the sacrifice of the radial artery, which, in our opinion, is a minor drawback if compared to the quality of the results. V C 2015 Wiley Periodicals, Inc. Microsurgery 35:608-614, 2015.

Study of the tendinous vascularization for the compound radial forearm flap plus flexor carpi radialis tendon

“…The mean number of nutritive branches larger than 0.2 mm (mean 0.33, range 0.2-0.6) going into the flap was 9.5 (range [8][9][10][11][12]. Five to eight most distal perforators directly reached the paratenon from the radial artery (or its volar division branch, once crossed the wrist), while one to five proximal perforators had an intramuscular course (distal belly of FCR), finally going into the myotendinous junction (Fig.…”

“…The presence of a long and strong vascularized tendon sliding under a very thin and pliable skin and the possibility of harvesting like a free flap offers an excellent solution also for reconstruction of distant areas, for example, foot and ankle [6,11,18]. We have a direct clinical experience in treating complex lesions of the Achilles tendon region with this compound free flap: we studied a series of six patients, observing good functional results after a mean follow-up of more than 36 months [11].…”

Reconstruction of complex soft tissue defects including tendons with anterolateral thigh flap extended to fascia lata: Long term recovery and functional outcomes

“…ROM (range of motion) of reconstructed joint was evaluated with a goniometer (Innocenti et al, ), muscles strength were scored (M0‐M5), according to established protocols. Pain at donor or recipient site was investigated by Visual Analogue Scale (VAS, score 0‐10).…”

Results of Application of Xenopericardial Prostheses in the Surgical Treatment of Subcutaneous Degenerative Achilles Tendon Ruptures

“…Долгосрочный ретроспективный анализ результатов отечественных и зарубежных авторов [1,5], применявших методики аутопластики дефектов ахиллова сухожилия, выявил существенное снижение качество жизни пациентов, обусловленное длительной иммобилизацией, что приводит к атрофии мышц и формированию контрактур суставов и высоким процентом воспалительных осложнений. Предлагаемые синтетические материалы [6], позволяют устранить анатомический дефект ахиллова сухожилия, но существенный недостаток «синтетики», ограничивающий ее применение в пластике ахиллова сухожилия, кроется в разнице биомеханических свойств этих материалов и нативного тендона, приводящих к таким осложнениям, как тугоподвижность суставов, ограничение в ношении обуви, атрофия мышц, снижение силы задних мышц голени, высокий риск воспалительных осложнений [7].…”