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 PlanningDesign flap and use Doppler ultrasound for perforator mapping.
Step 2: Debride Wound and Prepare Recipient VesselsUse a two-team approach, one for the affected side and one for the unaffected side.
Step 3: Harvest the Composite ALT FlapTake care to include one or two perforator vessels in the flap and to avoid vessel damage throughout the dissection.
Step 4: Perform Vascular AnastomosisUse the posterior tibial vessel as the recipient site for the microvascular anastomosis.
Step 5: Reconstruct the Achilles TendonSuture 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. ImagesFor 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 Indications
Pitfalls & Challenges
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. To achieve acceptable restoration in younger and athletic adults with combined loss of the Achilles tendon and the overlying soft tissues, both skin coverage and functional repair of the Achilles tendon are needed1,2.
Multiple surgical approaches have been used to repair Achilles tendon defects3,4. Conventionally, the soft-tissue defect of the exposed Achilles tendon is first covered, with use of a local, regional, or distant flap as a free flap2,3 …
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