Reconstruction of Open Contaminated Achilles Tendon Injuries With Soft Tissue Loss

Jepegnanam, Thilak Samuel; Nithyananth, Manasseh; Boopalan, P.R.J.V.C.; Cherian, Vinoo Mathew; Titus, V. T. K.

doi:10.1097/ta.0b013e31817c96c7

Cited by 18 publications

(17 citation statements)

References 13 publications

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“…Pivot point of the flap usually located 5 cm to 8 cm above the tip of lateral malleolus. 17,18 Position of pivot point may affect the total length, LWR, and location of top-edge; and the three parameters are positively related with partial necrosis in our study; however, our data showed that there was no close relationship between position of the pivot point and partial necrosis.…”

Section: Discussioncontrasting

confidence: 80%

Influence of flap factors on partial necrosis of reverse sural artery flap

Wei

Dong

et al. 2012

Journal of Trauma and Acute Care Surgery

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Section: Discussioncontrasting

confidence: 80%

Influence of flap factors on partial necrosis of reverse sural artery flap

Wei

Dong

et al. 2012

Journal of Trauma and Acute Care Surgery

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“…Complex defects in the posterior ankle region with segmental defects of the Achilles tendon pose a reconstructive challenge. [2] Two modalities of treatment have been described. The classical method is to do tendon reconstruction using various tendon grafts along with soft-tissue cover using a local or free flap.…”

Section: Discussionmentioning

confidence: 99%

“…Various complex secondary reconstructive procedures for Achilles tendon and soft-tissue defects have been propagated by many authors and all claim equally good results. [1][2][3][4][5][6][7][8][9][10][11][12][13] Saunders, et al, [14] have even suggested that if adequate wound healing is ensured by appropriate soft-tissue cover, good plantar flexion and even push off can be achieved, but no further investigations have been carried out to substantiate this.…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of segmental defects of Achilles tendon: Is it a must in infected complex defects?

Sabapathy

Venkataramani

Latheef

et al. 2013

Indian J Plast Surg

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Loss of Achilles tendon combined with overlying soft tissue loss is a challenging problem. Multiple techniques like tendon graft with coverage by soft tissue flap or composite flaps have been used. All these options are technically demanding. Reports do exist whereby muscle flaps bridging the defect used as cover in course of time could transmit the tendon force across the defect. We are presenting a case where a free gracilis muscle flap used to cover the soft tissue defect at the Achilles tendon at 2 years follow up provided stable cover and produced active function of the Achilles tendon allowing the patient to stand tip toe. Mechanism of its action has been analysed by MRI and M-mode ultrasound. While in primary Achilles tendon injury reconstruction is still the recommended option, in complex situations mere filling of the gap with the flap without formal reconstruction of the tendon could give good functional outcome. This technique can be used in demanding situations.

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“…In this situation, the timing of the flap becomes almost as important as the cover itself. [1415] The other approach is to perform both procedures by a single team. Masquelet described this as a holistic approach to open fractures rather than subjecting the patient to multiple surgical procedures by different teams at different intervals.…”

Section: Discussionmentioning

confidence: 99%

Experience of using local flaps to cover open lower limb injuries at an Indian trauma center

Boopalan

Nithyananth

Titus

et al. 2011

J Emerg Trauma Shock

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Background:Optimal care of open, high-velocity, lower limb injury requires surgical skills in debridement, skeletal stabilization, and in providing appropriate soft tissue cover. Timely coordination between orthopedic and plastic surgeons, though ideal, is often difficult. In our center, orthopedic surgeons undertake comprehensive treatment of open fractures including soft tissue cover. We reviewed the results of the local flaps of lower limb, done by orthopedic surgeons.Materials and Methods:We retrospectively reviewed the results of the lower limb flaps done between January 2005 and December 2006. All flaps done at and below the level of knee were included.Results:There were 105 patients with 120 flaps during this period. Two patients with two flaps were lost to follow-up. The average age was 32 years. Sixty-four patients had Type IIIB Gustilo and Anderson injuries. Thirty-nine patients had isolated soft tissue injuries. The indications for flaps were exposed bone, tendon, and joint in 45, 11, and 12, respectively, or a combination in 35 patients. The flaps done were 51 reverse sural artery, 35 gastrocnemius, 25 local fasciocutaneous, and seven foot flaps. The flap dimensions ranged from 2 × 2 to 30 × 15 cm. Ninety-three flaps (79%) healed primarily. Among 25 flaps (21%) with necrosis, 14 flaps required secondary split skin graft for healing, while the other nine flaps healed without further surgery.Conclusion:Appropriate soft tissue cover provided by orthopedic surgeons can help in providing independent, composite care of lower limb injuries.

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Reconstruction of Open Contaminated Achilles Tendon Injuries With Soft Tissue Loss

Abstract: In the management of complex tendo-achilles injuries with tendon and soft tissue loss, radical debridement, single stage tendon reconstruction, and reverse flow sural artery flap gives good functional outcome. This gives consistent results across a spectrum of open tendo-achilles injury.

Cited by 18 publications

References 13 publications

Influence of flap factors on partial necrosis of reverse sural artery flap

Influence of flap factors on partial necrosis of reverse sural artery flap

Reconstruction of segmental defects of Achilles tendon: Is it a must in infected complex defects?

Experience of using local flaps to cover open lower limb injuries at an Indian trauma center

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