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

Abstract

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.

Non-microsurgical bipedicled reverse sural fasciocutaneous flap with preservation of medial and lateral sural cutaneous nerve: Current surgical management of skin defect after traumatic Achilles tendon rupture – A case report

“…Although it was a small defect, the Achilles tendon will exposed and prone to infection and the tendon would be exhausted, finally the functional of the limb won’t be restored [ [1] , [2] , [3] ]. The traditional method of harvesting reverse sural flap is either fasciocutaneous or adipofascial, which told by many literatures and different techniques, chosen by the surgeon preference without any differences of flap size, pedicle length, and flap rotation angle [ [4] , [5] , [6] , [7] ]. Other advantage of sural flap is reduce the time-consuming of microsurgical procedure that provided by free flap, simple design and requires a small team and less instrumentation in operating room [ 4 , 8 , 9 ].…”

“…The Transparency document associated with this article can be found in the online version [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] ]. Transparency Document…”

“Repair and Flap technique”: A Retrospective Analysis of Single Stage Reconstruction Method for Treatment of Chronic Open Achilles Tendon Defect with Proximal Turndown Flap and Reverse Sural Flap

“…The treatment of chronic open wound includes debridement of the wound and achieve a healthy granulation tissue and cover with split thickness skin graft [9]. The other reconstruction options following debridement includes use of the local pedicle flap and microvascular flap [7,[10][11][12][13] . We have compared the outcomes of current study with various published studies in which reverse sural flap was used for reconstruction (Table 2) [1,10,[17][18][19][20][21].…”

Plasty of Achilles region with propeller tendon-fasciocutaneous peroneal artery perforator flap after radical excision of a neglected squamous cell carcinoma

“…Traditional free muscle flaps are latissimus dorsi and gracillis while fasciocutaneous flaps, while the most frequently used are the lateral arm and the anterolateral thigh flap. The choice depends mostly of patients' needs in terms of defect size, composition, comorbidities but equally on surgeons' preference and expertise [11,12].…”