One-Stage Reconstruction for Re-rupture of Achilles Tendon with Soft Tissue Infection: Using an Anterolateral Thigh Flap Incorporating a Vascularized Muscle Flap and a Strip of Iliotibial Tract

Abstract

Reconstruction is challenging in a patient with loss of a segment of Achilles tendon and infection in the overlying soft tissue. Here the authors describe one-stage tendon reconstruction, using an anterolateral thigh free flap incorporating a vascularized muscle flap and a strip of iliotibial tract in a patient with re-rupture of an Achilles tendon and soft tissue infection. Postoperative immobilization of the affected ankle using an external fixator enabled us to observe the flap directly and reduce pressure on the flap. The patient had a successful outcome, with no difficulty in walking, running, or climbing stairs and no limitation of range of motion at the ankle joint postoperatively. This is a promising technique for reconstruction of the Achilles tendon and treatment of infection as a one-step procedure.

Keywords

Achilles tendon - anterolateral thigh flap - one-stage reconstruction - re-rupture

• References

• 1 Costa ML, MacMillan K, Halliday D. et al. Randomised controlled trials of immediate weight-bearing mobilisation for rupture of the tendo Achillis. J Bone Joint Surg Br 2006; 88 (01) 69-77
• 2 Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med 1993; 21 (06) 791-799
• 3 Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg 2005; 13 (06) 417-427
• 4 Leppilahti J, Kaarela O, Teerikangas H, Raatikainen T, Orava S, Waris T. Free tissue coverage of wound complications following Achilles tendon rupture surgery. Clin Orthop Relat Res 1996; (328) 171-176
• 5 Kim CH, Tark MS, Choi CY, Kang SG, Kim YB. A single-stage reconstruction of a complex Achilles wound with modified free composite lateral arm flap. J Reconstr Microsurg 2008; 24 (02) 127-130
• 6 Innocenti M, Tani M, Carulli C, Ghezzi S, Raspanti A, Menichini G. Radial forearm flap plus flexor carpi radialis tendon in Achilles tendon reconstruction: surgical technique, functional results, and gait analysis. Microsurgery 2015; 35 (08) 608-614
• 7 Scaglioni MF, Hsieh CH, Giovanoli P, Chen YC. The posteromedial thigh (PMT) flap for lower extremity reconstruction. Microsurgery 7 37 (08) 865-872
• 8 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37 (02) 149-159