Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

ABSTRACT:

Introduction

Reconstruction to treat segmental loss of the Achilles tendon combined with soft-tissue defects can be challenging, particularly after the recurrent ruptures that may occur during intense physical activity.

Step 1 preoperative planning

Design flap and use Doppler ultrasound for perforator mapping.

Step 2 debride wound and prepare recipient vessels

Use a two-team approach, one for the affected side and one for the unaffected side.

Step 3 harvest the composite alt flap

Take care to include one or two perforator vessels in the flap and to avoid vessel damage throughout the dissection.

Step 4 perform vascular anastomosis

Use the posterior tibial vessel as the recipient site for the microvascular anastomosis.

Step 5 reconstruct the achilles tendon

Suture the rolled up vascularized fascia lata sheet; then check for tension.

Step 6 postoperative care

Gradual, protected weight-bearing begins at twelve weeks.

Results & preop/postop images

For recurrent tendon rupture, this single-step reconstruction saves both time and expense and it provides a functional tendon reconstruction (enabling normal daily activities) with limited donor-site morbidity and an acceptable cosmetic result without the need for a later debulking procedure.

What to watch for

IndicationsContraindicationsPitfalls & Challenges.

SUBMITTER: Duhamel P 

PROVIDER: S-EPMC8318354 | biostudies-literature |

REPOSITORIES: biostudies-literature