Treatment of infected Achilles tendinitis and overlying soft tissue defect using an anterolateral thigh free flap in an elderly patient

Lee, Young-Keun; Lee, Malrey

doi:10.1097/md.0000000000011995

Cited by 17 publications

(15 citation statements)

References 16 publications

(18 reference statements)

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“…It is important to recognize that the fascia is responsible for supporting the arch and absorbing shock. It is notable that despite the segment "itis," there are no inflammatory cells present in this condition [1,2,3]. Several factors can contribute to plantar fasciitis, but overuse stress is the most common cause.…”

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confidence: 99%

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan

Khired¹,

Najmi²,

Akkur³

et al. 2022

Cureus

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BackgroundPlantar fasciitis develops as a consequence of irritation of the plantar fascia, which is responsible for supporting the arches and absorbing shock. Multiple factors can contribute to plantar fasciitis, but the most common factor is overuse stress. The classical presentation is a sharp pain that is felt at the plantar aponeurosis (near the area of its insertion on the medial process of the calcaneal tuberosity), and it is possible to find a heel spur (osteophyte) in some cases. Most treatments for plantar fasciitis are ineffective and unsatisfactory for patients. ObjectiveTo estimate the prevalence and assess risk factors for plantar fasciitis among the population of the Jazan region. MethodsA cross-sectional online survey was conducted on the population of the Jazan region. An online Google form questionnaire was prepared and distributed to the study population. Data was then entered and analyzed using IBM SPSS (Statistical Package for the Social Sciences) Statistics, version 21.0. ResultsA total of 695 participants were enrolled in the study. Out of that, 350 (50.4%) of the participants were males, while 345 (49.6%) were females. About the age of the participants, 507 (72.9%) were younger than 40 years of age. Participants with hypertension were 43 (6.2%), and 37 (5.3%) participants had diabetes. In terms of occupation, 120 (17.3%) worked in healthcare, 187 (26.9%) taught, and 43 (6.2%) served in the military. A great quantity of standing or walking was necessary for the jobs for 127 people (18.3%), while moderate amounts were recorded for 273 people (39.3%). The most commonly reported lower limb conditions were: pes planus (low arches) in 26 (3.7%) participants; and weakness of the gastrocnemius, soleus, and intrinsic foot muscles. The most commonly reported exercises were walking for 499 (71.8%) participants and jogging for 97 (14%) participants. The prevalence of plantar fasciitis was found to be 37% of the participants. Regarding the Foot and Ankle Outcome Score (FAOS) survey, the mean symptoms subscale score was 57.81 + 11.28, the mean pain subscale score was 72.87±20.84, the mean daily living subscale score was 72.73 ± 22.25, the mean sports and recreation subscale score was 76.83 ± 23.06, and the mean quality of life subscale score was 70.23 ± 25.17. Multivariate logistic regression was done and the following factors predicted a higher rate of plantar fasciitis: being 40 to 55 years old (p < 0.001, odds ratio = 2.15), being 56 to 65 years old (p = 0.037, odds ratio = 3.58), being obese (p = 0.031, odds ratio = 2.16), having weakness of the gastrocnemius, soleus, and the intrinsic foot muscles (p = 0.003, odds ratio = 7.39), jobs requiring a great amount of time standing or walking (p < 0.001, odds ratio = 3.17), and jobs requiring a moderate amount of time standing or walking (p = 0.012, odds ratio = 1.83). Being male predicted a lower rate of plantar fasciitis (p < 0.001, odds ratio = 0.52). ConclusionPlantar fasciitis is a prevalent and disabling condition with considerable effects on quality...

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confidence: 99%

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan

Khired¹,

Najmi²,

Akkur³

et al. 2022

Cureus

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“…The ideal reconstructive option is free tissue transfer and various types of composite free flaps have been proposed for small defects in the Achilles tendon region, including muscle flap, musculocutaneous flap, fasciocutaneous flap, and perforator flap (Abhyankar et al, 2009; Berthe et al, 1998; Huemer et al, 2012; Kim et al, 2003; Lee et al, 1999; Papp et al, 2003; Smit et al, 2012; Yajima et al, 2001; Yuen & Nicholas, 2001). The ALT flap with vascularization source from perforators of the descending branch of LCFA paved the way for the use of new materials to reconstruct large skin defects or chronic wound infections at the ankle (Lee et al, 2000; Lee & Lee, 2018; Nosrati et al, 2012). Several authors presented the application of composite free ALT flap with the FL to reconstruct the complicated Achilles tendon and skin defects.…”

Section: Discussionmentioning

confidence: 99%

“…Free flaps were suitable for simultaneous reconstruction of the Achilles tendon and complex soft tissue defects (Fischer et al, 2013). In 1984, the anterolateral thigh (ALT) flap described by Song et al became the preferred alternative for skin defect reconstruction (Song et al, 1984), especially in lower extremity soft tissues (Lee et al, 2000; Lee & Lee, 2018; Nosrati et al, 2012). In 1990, the use of ALT flaps with vascularized fascia lata in Achilles tendon rupture was first reported by Inoue et al (Inoue et al, 1990).…”

Section: Introductionmentioning

confidence: 99%

One‐stage reconstruction of the massive overlying skin and Achilles tendon defects using a free chimeric anterolateral thigh flap with fascia lata

et al. 2022

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Background: Treatment for large defects in the non-weight-bearing Achilles tendon and soft tissues remains a reconstructive challenge. The free composite anterolateral thigh flap (ALT) with fascia lata (FL) has been indicated in the single-stage reconstruction of the Achilles tendon and soft tissue defect and this technique remain some disadvantages, such as the inability to perform primary flap thinning, requiring secondary flap thinning, and the delayed normalization of the range of motion of the ankle joint. The free chimeric ALT flap with FL was introduced as a novel alternative with many advantages in reconstructing the Achilles tendon and soft tissue defects. This paper reports the reconstruction of the massive Achilles tendon and overlying skin defects using free chimeric ALT flaps with FL. Methods: From June 2017 to October 2020, we performed on a series of 5 patients receiving free chimeric ALT flaps with FL to reconstruct the Achilles tendon and soft tissue defects. The age of patients ranged from 43 to 62 years old. All five patients had full-layer defects of the Achilles tendon with infection. The sizes of the skin defects ranged from 6 Â 4 cm to 12 Â 10 cm. The perforators from the descending branch of the lateral circumflex femoral arteries are located using a handheld Doppler. The perforators help to design the outline of the ALT flap and fascia flap. The skin flap was thinned under microscopy if the flap was too thick. The anastomosis was accomplished before insetting the flaps into the defect.Results: The size of the ALT flap ranged from 10 Â 5 cm to 15 Â 12 cm, and the size of the FL flap ranged from 7 Â 4 cm to 10 Â 8 cm. The mean perforator length for the skin flap and fascia lata was 3.3 cm (range, 2.5-5.0 cm) and 5.3 cm (range, 3.5-7.0 cm), respectively. Four patients received skin flap thinning up to 57%-79% of the flap thickness, while one patient did not need to debulk. The thickness of the ALT flap ranged from 6 to 13 mm. All the flaps survived completely and postoperative

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“…The soft-tissue defects of the distal lower extremities are common in the elderly patients, and the reconstructions of these defects are full of challenges because of many comorbidities. Many flaps, such as free flaps [ 1 ], perforator flaps [ 2 ], myocutaneous flaps [ 3 ], and regional pedicled flaps [ 4 ] have been used to repair the defects in such areas, and each has its own advantages, disadvantages and indications. Free flaps are considered by many surgeons to be the gold standard for reconstruction of the soft tissue defects [ 1 , 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Many flaps, such as free flaps [ 1 ], perforator flaps [ 2 ], myocutaneous flaps [ 3 ], and regional pedicled flaps [ 4 ] have been used to repair the defects in such areas, and each has its own advantages, disadvantages and indications. Free flaps are considered by many surgeons to be the gold standard for reconstruction of the soft tissue defects [ 1 , 5 – 7 ]. However, due to the complexity of the operation and the need for longer operation and anesthesia durations, the elderly patients are subjected to more postoperative complications [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

Reliability of distally based sural flap in elderly patients: comparison between elderly and young patients in a single center

et al. 2021

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Background Reconstructions the soft-tissue defects of the distal lower extremities in the elderly patients (≥ 60 years old) are full of challenges because of many comorbidities. The purpose of this study was to report the clinical application of the distally based sural flap in the elderly patients, and to verify the reliability of this flap in the elderly patients. Methods Between March of 2005 and December of 2019, 53 patients aged over 60-year-old and 55 patients aged 18 to 30-year-old who underwent the procedure have been included in this study. The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors are compared between the group A (≥ 60 years old) and group B (ranging from 18 to 30 years old). Results The partial necrosis rate in group A (9.43%) is higher than group B (9.09%), but the difference is not significant (P > 0.05). The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method (i.e., skin grafting) is 96.22% and 98.18% in group A and B, respectively (P > 0.05). The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B (P > 0.05). Conclusions The distally based sural flap can be effectively used to repair the soft-tissue defect of the lower extremity in the elderly patients. It is safe and reliable to harvest and transfer the flap in one stage, and the delay surgery is not necessary.

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Treatment of infected Achilles tendinitis and overlying soft tissue defect using an anterolateral thigh free flap in an elderly patient

Cited by 17 publications

References 16 publications

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan

The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan

One‐stage reconstruction of the massive overlying skin and Achilles tendon defects using a free chimeric anterolateral thigh flap with fascia lata

Reliability of distally based sural flap in elderly patients: comparison between elderly and young patients in a single center

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