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Elhefnawy AA, Hantash SA, Mahmoud WH, Homouda WI, Khedr MM. Versatility of Local Fasciocutaneous Island Flaps for Resurfacing Soft Tissue Defects Overlying the Achilles Tendon. World J Plast Surg 2023; 12:20-28. [PMID: 37220583 PMCID: PMC10200086 DOI: 10.52547/wjps.12.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 05/25/2023] Open
Abstract
Background Reconstruction of soft tissue defects overlying the Achilles tendon has always been a challenge. Various modalities of reconstruction have been described to resurface such defects. We aimed to assess the functional and cosmetic outcomes of all patients who had undergone reconstruction of small and medium sized soft tissue defects of the Achilles region using local fasciocutaneous island flaps. Methods This retrospective study was conducted from January 2020 to June 2022. 15 patients with small (≤ 30 cm2) and medium (30-90 cm2) sized soft tissue defects of the tendo-Achilles region, underwent reconstruction with local fasciocutaneous island flaps and had complete medical records, were included. Results Thirteen patients were male (86.7%). The mean age was 53.2 years. 5 cases (33.3%) had post-traumatic open AT injuries with skin avulsion, while ten patients (66.7%) had suture line complications after open repair of spontaneous Achilles tendon rupture. Defect sizes ranged from 12 to 63 cm2. Reverse sural flap was used in 5 patients (33.3%) and medial plantar flap in 10 patients (66.7%). All flaps survived completely. Complications were detected in 3 patients (20%); 1 distal superficial necrosis in a sural flap and 2 marginal minimal graft loss. Functional outcome was good in 12 patients (80%), excellent in 1 patient (6.7%) and fair in 2 patients (13.3%). 13 patients (86.7%) were satisfied with the cosmetic results. Conclusion Local fasciocutenous island flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes.
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Affiliation(s)
- Ahmed A. Elhefnawy
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sherif A. Hantash
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Wael H. Mahmoud
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Wesam I. Homouda
- Plastic Surgery Department, Benha Teaching Hospital, Benha, Egypt
| | - Mohamed M. Khedr
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
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Hackenberg RK, Täger S, Prangenberg C, Kabir K, Welle K. Reconstruction of Complicated Achilles Tendon Ruptures with Soft Tissue Defects - a Systematic Overview and Development of a Treatment Algorithm. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:314-322. [PMID: 31958851 DOI: 10.1055/a-1073-8516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Achilles tendon ruptures are among the most common ruptures of large tendons. Due to the vulnerable soft tissue there is a high risk of soft tissue defects. The combination of Achilles tendon ruptures and soft-tissue defects remains a challenge for the surgeon. Despite different treatment options there is a lack of structured treatment recommendation. By means of a systematic literature review and experience from our own clinic standard, an overview of the stepwise treatment options is presented. A treatment algorithm for reconstructive measures of Achilles tendon ruptures accompanied by soft-tissue defects according to the length of defect of the Achilles tendon, the size of the soft-tissue defect and patient-individual factors is developed. This is intended to serve the surgeon as a basis for decision making prior to application of therapy.
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Affiliation(s)
- Roslind Karolina Hackenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Stefan Täger
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Christian Prangenberg
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Koroush Kabir
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
| | - Kristian Welle
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Hand- und Plastisch-Rekonstruktive Unfallchirurgie, Universitätsklinikum Bonn
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3
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Okochi M, Momiyama M, Okochi H, Ueda K. Early mobilizing and dangling of the lower leg after one-stage reconstruction of Achilles tendon and overlying tissue defect using an anterolateral thigh flap with vascularized fascia lata. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:89-95. [PMID: 29152539 PMCID: PMC5678446 DOI: 10.1080/23320885.2017.1396902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/23/2017] [Indexed: 11/15/2022]
Abstract
We have treated two patients who had an Achilles tendon and overlying tissue defect using an anterolateral thigh flap with fascia lata. Postoperatively, skeletal suspension of the affected leg and intra-arterial heparin infusion were performed for seven days. Six weeks postoperatively, the patients could walk again.
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Affiliation(s)
- Masayuki Okochi
- Department of Plastic and Reconstructive Surgery, Fukushima Medical UniversityFukushimaJapan
| | - Masanori Momiyama
- Department of Plastic and Reconstructive Surgery, Fukushima Medical UniversityFukushimaJapan
| | - Hiromi Okochi
- Department of Plastic and Reconstructive Surgery, Fukushima Medical UniversityFukushimaJapan
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery, Fukushima Medical UniversityFukushimaJapan
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Bae SH, Lee HS, Seo SG, Kim SW, Gwak HC, Bae SY. Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair. J Bone Joint Surg Am 2016; 98:1161-7. [PMID: 27440563 DOI: 10.2106/jbjs.15.01117] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon as well as the thin surrounding soft tissue. For treatment of an infected Achilles tendon following tendon repair, we first focused on complete debridement and then promoted fibrous scar healing of the Achilles tendon using functional treatment. METHODS We retrospectively reviewed all of the medical records of 15 tertiary referral patients with postoperative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, 22 to 97 months). The infected tissue and the necrotic tendon were debrided, and the ankle was placed in a short leg splint for 2 weeks. The splint was then replaced with an ankle brace for the next 4 weeks. Partial weight-bearing was allowed immediately, and full weight-bearing was allowed at 2 weeks postoperatively. We assessed and recorded the physical parameters such as the range of motion, calf circumference, ability to perform a single-limb heel rise, patient satisfaction, and Arner-Lindholm scale. Laboratory tests, postoperative ultrasonography, and isokinetic plantar flexion power tests were also performed. RESULTS At a mean time of 17 days (range, 8 to 30 days) after debridement, infection signs such as discharge from the wound, redness, and local warmth resolved. The wound had healed and the stitches were removed at a mean of 17 days following the wound repair. At the time of the latest follow-up, there were no signs of active infection. Achilles tendon continuity recovered in all patients by fibrous scar healing. Compared with the contralateral side, there was no difference in the ankle range of motion in 8 patients. According to the Arner-Lindholm scale, 9 of the 15 results were excellent and 6 were good. Ten patients were able to perform a single-limb heel rise. Eleven of 15 patients returned to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity was observed on the ultrasonographic examination. CONCLUSIONS In this retrospective series, radical debridement, combined with antibiotic therapy and functional rehabilitation, was successful in eradicating infection and maintaining function in patients with postoperative infection following Achilles tendon repair. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Seung Hwan Bae
- Department of Orthopedic Surgery, Cheongju Ppuri Medical Center, Cheongju, Republic of Korea
| | - Ho-Seong Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Gyo Seo
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Woo Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Heui-Chul Gwak
- Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Su-Young Bae
- Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
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Schade VL, Harsha W, Rodman C, Roukis TS. Peroneal Tendon Reconstruction and Coverage for Treatment of Septic Peroneal Tenosynovitis: A Devastating Complication of Lateral Ankle Ligament Reconstruction With a Tendon Allograft. J Foot Ankle Surg 2015; 55:406-13. [PMID: 26002675 DOI: 10.1053/j.jfas.2015.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Indexed: 02/03/2023]
Abstract
Septic peroneal tenosynovitis is a rare and significant challenge. A search of peer-reviewed published studies revealed only 5 case reports to guide treatment, none of which resulted in significant loss of both peroneal tendons necessitating reconstruction. No clear guidance is available regarding how to provide reliable reconstruction of both peroneal tendons after a significant loss secondary to septic tenosynovitis. In the present report, we describe the case of a young, active-duty soldier who underwent lateral ankle ligament reconstruction with a tendon allograft whose postoperative course was complicated by septic peroneal tenosynovitis resulting in significant loss of both peroneal tendons. Reconstruction was achieved in a staged fashion with the use of silicone rods and external fixation to maintain physiologic tension and preserve peroneal tendon function, followed by reconstruction of both peroneal tendons and the superior peroneal retinaculum with a tensor fascia lata autograft. Soft tissue coverage was obtained with an anterolateral thigh free tissue transfer and a split-thickness skin graft. The patient returned to full activity as an active-duty soldier with minimal pain and no instability of the right lower extremity. The muscle strength of both peroneal tendons remained at 5 of 5, and no objective findings of ankle instability were seen at 3.5 years postoperatively.
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Affiliation(s)
| | - Wayne Harsha
- Chief, Otolaryngology Service, Madigan Army Medical Center, Tacoma, WA
| | - Caitlin Rodman
- Staff, Adult Family Nurse Practitioner, South Sound Internal Medicine, Olympia, WA
| | - Thomas S Roukis
- President, American College of Foot and Ankle Surgeons, Chicago, IL; Attending Staff, Department of Orthopedics, Podiatry, and Sports Medicine, Gundersen Health System, La Crosse, WI
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Michel G, Ho Quoc C, Assaf N, Delay E, Sinna R. Reconstruction dynamique de tendon d’Achille par lambeau perforant composite avec évaluation fonctionnelle. ANN CHIR PLAST ESTH 2015; 60:78-83. [DOI: 10.1016/j.anplas.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
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Upadhyaya DN, Khanna V, Kohli R, Tulsi SPS, Garg S. Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap. Indian J Plast Surg 2013; 45:572-5. [PMID: 23450740 PMCID: PMC3580366 DOI: 10.4103/0970-0358.105983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Managing the complex tendo Achilles defect involves reconstructing the Achilles tendon as well as providing soft tissue cover to the heel area. The advent of microsurgery has revolutionised the reconstruction of this difficult defect providing a number of options to the reconstructive surgeon. We present a case of complex tendo Achilles defect reconstructed by the latissimus dorsi free flap.
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Affiliation(s)
- Divya N Upadhyaya
- Department of Plastic, Craniofacial and Microsurgery, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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8
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Karagöz H, Öksüz S, Ülkür E, Sever C, Şahi̇n C, Külahçi Y. Definitive foot drop deformity repair with tensor fascia latae myocutaneous flap. Microsurgery 2012; 33:223-6. [DOI: 10.1002/micr.22065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 10/11/2012] [Accepted: 10/15/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Hüseyi̇n Karagöz
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Burn Unit, Istanbul, Turkey
| | - Si̇nan Öksüz
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Burn Unit, Istanbul, Turkey
| | - Ersi̇n Ülkür
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Burn Unit, Istanbul, Turkey
| | - Celaletti̇n Sever
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Burn Unit, Istanbul, Turkey
| | - Ci̇han Şahi̇n
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Burn Unit, Istanbul, Turkey
| | - Yalçin Külahçi
- Gulhane Military Medical Academy, Haydarpasa Training Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Burn Unit, Istanbul, Turkey
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9
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V–Y gastrocnemius muscle slide with turnover fascial flap for compound Achilles defects: A simple solution. J Plast Reconstr Aesthet Surg 2010; 63:e406-10. [DOI: 10.1016/j.bjps.2009.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 09/11/2009] [Accepted: 09/20/2009] [Indexed: 10/20/2022]
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10
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One-stage treatment of deep infection following repair of Achilles tendon rupture with flexor hallucis longus transfer. Knee Surg Sports Traumatol Arthrosc 2009; 17:313-5. [PMID: 18985318 DOI: 10.1007/s00167-008-0657-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 10/08/2008] [Indexed: 11/27/2022]
Abstract
We present one-stage treatment of deep infection following repair of Achilles tendon rupture using flexor hallucis longus transfer. Flexor hallucis longus was used not only to connect the defect in Achillles tendon, but also to control the soft tissue infection with its abundant blood supply, simultaneously. The clinical results for the two patients in this report were excellent without major complication.
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11
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Arslan E, Milcan A, Aksoy A, Unal S, Demirkan F. Use of Distally Based Cross-Leg Sural Artery Flap and Cadaveric Achilles Tendon Graft in the Reconstruction of a Combined Defect of the Achilles Tendon and Overlying Soft Tissue. Plast Reconstr Surg 2006; 117:1365-7. [PMID: 16582832 DOI: 10.1097/01.prs.0000205579.30761.f8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Dabernig J, Shilov B, Schumacher O, Lenz C, Dabernig W, Schaff J. Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap. J Plast Reconstr Aesthet Surg 2006; 59:142-7. [PMID: 16703858 DOI: 10.1016/j.bjps.2005.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present our experience in functional reconstruction of the Achilles tendon with large tissue defects following after trauma and infection. To cover the skin defect and to reconstruct the Achilles tendon we used the free tensor fasciae latae (TFL) flap. From 1997 to 2003 six males, ranging from 22 to 71 (average 38.6) years, underwent this reconstructive procedure. All of them had sustained a trauma with following loss of the tendon and of the overlying tissue. After initial debridements the reconstruction with a tensor fascia latae free flap was performed. To achieve a strong distal fascia lata attachment to the calcaneal bone, we developed a special method of fixation. After vertical osteotomy in the calcaneus the distal part of the fascia flap was introduced between the bone segments, which were fixed together with a spongiosa screw. For functional outcome, it was important to fix the foot in a 90 degrees position with tension on the vascularised fascia lata. The range of motion of the ankle of the reconstructed foot showed 93.7% in comparison to the normal foot. No flap failure occurred in any of the six patients. Simultaneous soft-tissue and function restoration of the foot with TFL free flap is in our opinion an optimal one-stage reconstructive procedure.
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Affiliation(s)
- J Dabernig
- Department of Hand-, Micro- and Plastic Surgery, Amper Kliniken AG, Klinikum Dachau, 85221 Dachau, Germany.
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13
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Cavadas PC, Landin L. Reconstruction of Chronic Achilles Tendon Defects with Posterior Tibial Perforator Flap and Soleus Tendon Graft: Clinical Series. Plast Reconstr Surg 2006; 117:266-71. [PMID: 16404278 DOI: 10.1097/01.prs.0000194905.25604.f8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstruction of chronic composite defects of the Achilles region is difficult, and many techniques have been proposed, most of which are technically complex. A simple and effective technique has not yet been described. METHODS Eight patients with chronic composite defects of the Achilles tendon underwent reconstruction using a local tendon graft from the soleus tendon and a posterior tibial perforator flap in a single stage. Follow-up was 9 to 50 months. RESULTS All reconstructions were successful, without flap loss, infections, or reruptures of the tendon. Minor skin graft loss over the flap was a complication in three cases. Patient satisfaction was uniformly high. CONCLUSION The posterior tibial perforator flap combined with a local tendon graft from the soleus tendon is an effective and technically simple solution for reconstruction of chronic infected defects of the Achilles tendon of moderate size.
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Affiliation(s)
- Pedro C Cavadas
- Division of Reconstructive and Hand Surgery, Centro de Rehabilitación de Levante, Valencia, Spain.
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14
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Ronel DN, Newman MI, Gayle LB, Hoffman LA. Recent advances in the reconstruction of complex Achilles tendon defects. Microsurgery 2003; 24:18-23. [PMID: 14748019 DOI: 10.1002/micr.10191] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Large, complex lower-extremity defects in the region of the Achilles tendon occur when tendon loss or disruption is complicated by damage to surrounding structures, including soft tissue, vessels, or bone. The surgical approach to these complex defects has evolved from simple amputation to the recognition that satisfactory reconstruction has three components: functional reconstruction of the tendon, importation of vascularized soft tissue, and skin coverage. Many techniques have been developed to address these difficult reconstructive goals, which often require multiple procedures or complicated single-stage operations. Microsurgical advances have begun to reduce the complexity of Achilles tendon region reconstruction, and excellent results can be obtained which restore function, form, and cosmesis with minimal morbidity.
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Affiliation(s)
- Daniel N Ronel
- Division of Plastic Surgery, New York-Presbyterian Hospital, New York, NY, USA.
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15
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Kuo YR, Kuo MH, Chou WC, Liu YT, Lutz BS, Jeng SF. One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment. Ann Plast Surg 2003; 50:149-55. [PMID: 12567051 DOI: 10.1097/01.sap.0000037270.95257.b9] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The combined loss of the Achilles tendon with overlying soft tissue is a reconstructive challenge. To achieve acceptable rehabilitation, such patients need skin coverage including functional repair of the Achilles tendon. This article presents four such patients who were treated successfully by means of an anterolateral thigh (ALT) composite flap with vascularized fascia lata. The size of the ALT flaps ranged from 10 to 16 cm in length and 6 to 9 cm in width. All flaps included vascularized fascia lata, which was rolled to serve as vascularized tendon graft (range 8 x 6 cm to 10 x 8 cm) for reconstruction of the Achilles tendon defect. Flap success rate was 100%. All patients could walk and climb stairs without support; however, mild difficulty when running was reported. Functional outcome of the recipient ankle and donor thigh morbidity were investigated by using a kinetic dynamometer comparing reconstructed sides with the healthy contralateral limbs. This assessment was performed in two patients at 2 years postoperatively. In the reconstructed ankles, isokinetic concentric measurements of dorsiflexion and plantar flexion showed a deficit of 30% and 40%, respectively. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed a 10% to 25% deficit. However, there were no difficulties in daily ambulating. In summary, the free composite ALT flap with vascularized fascia lata provides an alternative option for Achilles tendon reconstruction in complex defects.
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Affiliation(s)
- Yur-Ren Kuo
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Kaohsiung, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan
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16
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Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am 2002; 84:2016-21. [PMID: 12429764 DOI: 10.2106/00004623-200211000-00017] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The incidence of total Achilles tendon rupture has increased, but we are not aware of any reports on the incidence of reruptures or deep infections following treatment. The outcome after successful treatment is good, but that after complications has not been well documented. METHODS A group of 409 patients with a complete Achilles tendon rupture was treated at a university hospital orthopaedic unit between 1979 and 2000. Twenty-three reruptures (prevalence, 5.6%) and nine deep infections (prevalence, 2.2%) occurred in twenty-nine patients. We retrospectively reviewed the records of these patients to determine the overall incidence of ruptures, reruptures, and deep infections and to record the known risk factors for these major complications. We analyzed the final clinical outcome for twelve patients with a rerupture and seven patients with a deep infection at a mean of 4.1 years after the initial treatment. RESULTS The annual incidence of reruptures (per 100,000 inhabitants) increased from 0.25 in 1979-1990 to 1.0 in 1991-2000, and that of deep infections increased from 0 in the 1980s to 0.63 in the 1990s. The ratio of complications to primary ruptures did not change. The patients with deep infections were significantly older, received corticosteroid medication more often, had sustained the tendon injury during everyday activities more often, and had a longer delay before treatment than the patients with simple reruptures. At 4.1 years after the primary treatment, eight of twelve patients in the rerupture group had a satisfactory clinical outcome and the overall average isokinetic plantar flexion strength deficit in that group was only 10%. In contrast, two of the patients in the infection group had a fair clinical outcome and five had a poor outcome, and the average isokinetic plantar flexion strength deficit in that group was 35%. CONCLUSIONS The incidence of Achilles tendon reruptures and deep infections has increased. The outcome is satisfactory after a simple rerupture without infection, but the results after a deep infection are often devastating.
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Affiliation(s)
- Ari Pajala
- Department of Orthopaedic Surgery, Oulu University Hospital, Box 22, 90220 Oulu, Finland
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17
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Yinger K, Mandelbaum BR, Almekinders LC. Achilles rupture in the athlete. Current science and treatment. Clin Podiatr Med Surg 2002; 19:231-50, v. [PMID: 12123143 DOI: 10.1016/s0891-8422(02)00002-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Achilles tendon ruptures became increasingly common in the latter half of the 20th century. Once the diagnosis is made, the patient's goals and objectives should be clearly stated. The treatment choice should incorporate the patient's needs, desires, objectives, and functional goals to assure an optimal result.
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Affiliation(s)
- Kent Yinger
- Redwood Orthopaedic Surgery Associates, 990 Sonoma Avenue, Suite 8, Santa Rosa, CA 95404, USA.
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