Single Stage Reconstruction of Ruptured Tendoachilles Tendon With Skin Cover Using Distally Based Superficial Sural Artery Flap

Abstract

Ruptured tendoachilles along with skin defect is a complex problem to reconstruct. Both things require a priority. Single stage reconstruction of ruptured tendoachilles tendon with skin cover using distally based superficial sural arterial flap allows us to perform both. This procedure gives excellent result, shortens the stay, thereby reducing the cost. This method is a simple solution to the complex problem like ruptured tendoachilles with skin defect. In this study, 6 patients with rupture of tendoachilles tendon due to penetrating injury, with skin defect are presented. The repair was done using aponeurotic part of tendoachilles tendon, taken from proximal part of tendoachilles in the midline measuring around 2 to 2.5 cm in width and 8 to 10 cm in length, with intact distal attachment. The tendon was turned upside down by 180 degrees and sutured to the distal stump of the tendoachilles tendon without tension. The skin defect was covered using distally based superficial sural artery flap in the same sitting. The follow-up period was 9 to 30 months. All patients showed good results. In one patient there was distal necrosis of 1.5 cm of the distally based superficial sural artery flap, which healed satisfactorily with conservative treatment. Single stage tendoachilles reconstruction can be used with good functional result and patient satisfaction.

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

“…Five out of six patients needed a small size split thickness skin graft at the donor site after a mean time of 7.1 days (range 7-9) of vacuum therapy to improve the granulation tissue and reduce the cosmetic impact on the forearm. DASH score values relating to the donor extremity resulted with a mean value of 8.0 points (range [3][4][5][6][7][8][9][10][11][12][13][14][15] with no significant functional impairment complained by patients. The MRI study at 8 months FU showed a nearly normal shape of the reconstructed tendon without interruptions, and the fusion between the two segments of FCR reaching in size the original Achilles tendon (Fig.…”

“…A composite vascularized flap, able to provide healthy tissues to simultaneously reconstruct both tendon and skin, may be a logical alternative. Several donor sites able to offer vascularized skin and tendon are available, and different flaps have been addressed in literature …”

“…Tendinous allografts and autologous non‐vascularized tendon graft may be an alternative, but with some concerns in treating an infected complex defect by means of non‐vascularized tissues. Several authors have recently reported the use of pedicled and free flaps as a solution for a multilayer reconstruction associated with good clinical outcomes . Among them, Stamate et al in 1998, and then Coşkunol et al in 2005 reported their experience respectively in two and one case using a free radial forearm flap augmented with a vascularized tendon of Flexor Carpi Radialis (FCR) muscle.…”

“…Several authors have recently reported the use of pedicled and free flaps as a solution for a multilayer reconstruction associated with good clinical outcomes. [6][7][8][9][10][11][12][13][14][15][16][17] Among them, Stamate et al 16 in 1998, and then Coşkunol et al 17 in 2005 reported their experience respectively in two and one case using a free radial forearm flap augmented with a vascularized tendon of Flexor Carpi Radialis (FCR) muscle.…”

When free flaps are not the first choice: is the distally based peroneus brevis still an option for foot and ankle reconstruction in the era of microsurgery?

“…While the distally based peroneus brevis muscle flap (PBF) was first reported by Donski and Fodgestan [16] , it became more popular when Masquelet described the surgical procedure in detail based on of his anatomical findings [17] and by Lyle and Colborn [18] . In our clinical routine it has been implemented as a workhorse for reconstructing small full thickness defects in the distal lower leg, ankle and heel [19][20][21][22][23][24] . Later papers added their experiences and highlighted the key points that need to be taken into account McHenry et al [25] and Eren et al [26] .…”