title: Reconstruction of open contaminated achilles tendon injuries with soft tissue loss.
abstract: BACKGROUND
  Open achilles tendon injuries, present a complex problem to the treating surgeon especially if associated with tendon and soft tissue loss. We present eight such patients treated with tendon repair/reconstruction and reverse flow sural artery flap for soft tissue cover.
  
  
  METHODS
  Eight patients (age, 12-64 years) with a spectrum of open tendo-achilles injuries of acute and chronic (infected), including loss of tendon of up to 10 cm, tendon defects with no distal attachment and one with partial loss of the calcaneum were treated between November 2005 and July 2006. Two of them had significant medical comorbid factors. The skin defect measured after debridement ranged from 6 x 5 cm to 15 x 10 cm. The tendon injuries were sutured directly when possible or sutured to bone if avulsed from the calcaneum. They were otherwise reconstructed using the central part of the proximal segment. A reverse sural artery was used to provide soft tissue cover.
  
  
  RESULTS
  All flaps survived. All patients had a normal gait, were able to stand on tip toes, had active plantar flexion and had returned to their original occupation 4 months after reconstruction. They had full range of movement at the ankle. One diabetic patient had terminal necrosis of the flap that required a split skin graft. He developed a late infection which did not compromise the functional result.
  
  
  CONCLUSIONS
  In the management of complex tendo-achilles injuries with tendon and soft tissue loss, radical debridement, single stage tendon reconstruction, and reverse flow sural artery flap gives good functional outcome. This gives consistent results across a spectrum of open tendo-achilles injury.
authors.affiliation: Department of Orthopaedics, St. Michael's Hospital, Toronto, Canada. thilakjepegnanam@yahoo.com
authors.forename: Thilak Samuel
authors.initials: TS
authors.lastname: Jepegnanam
authors.forename: Manasseh
authors.initials: M
authors.lastname: Nithyananth
authors.forename: Palapattu R J V C
authors.initials: PR
authors.lastname: Boopalan
authors.forename: Vinoo Mathew
authors.initials: VM
authors.lastname: Cherian
authors.forename: Vijay Titus K
authors.initials: VT
authors.lastname: Titus
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D000293:Adolescent; D002111:Calcaneus / Q000293:injuries / Q000601:surgery; D002648:Child; D003646:Debridement; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D009864:Ontario; D017695:Soft Tissue Injuries / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*; D053441:Suture Anchors; D013536:Suture Techniques; D014946:Wound Infection / Q000601:surgery*; D055815:Young Adult