title: Reconstruction of defects involving the Achilles tendon and local soft tissues: a quick solution for a lingering problem.
abstract: A total of seven patients (six men and one woman) with a defect in the Achilles tendon and overlying soft tissue underwent reconstruction using either a composite radial forearm flap (n = 3) or an anterolateral thigh flap (n = 4). The Achilles tendons were reconstructed using chimeric palmaris longus (n = 2) or tensor fascia lata (n = 2) flaps or transfer of the flexor hallucis longus tendon (n = 3). Surgical parameters such as the rate of complications and the time between the initial repair and flap surgery were analysed. Function was measured objectively by recording the circumference of the calf, the isometric strength of the plantar flexors and the range of movement of the ankle. The Achilles tendon Total Rupture Score (ATRS) questionnaire was used as a patient-reported outcome measure. Most patients had undergone several previous operations to the Achilles tendon prior to flap surgery. The mean time to flap surgery was 14.3 months (2.1 to 40.7). At a mean follow-up of 32.3 months (12.1 to 59.6) the circumference of the calf on the operated lower limb was reduced by a mean of 1.9 cm (sd 0.74) compared with the contralateral limb (p = 0.042). The mean strength of the plantar flexors on the operated lower limb was reduced to 88.9% of that of the contralateral limb (p = 0.043). There was no significant difference in the range of movement between the two sides (p = 0.317). The mean ATRS score was 72 points (sd 20.0). One patient who had an initial successful reconstruction developed a skin defect of the composite flap 12 months after free flap surgery and this resulted in recurrent infections, culminating in transtibial amputation 44 months after reconstruction. These otherwise indicate that reconstruction of the Achilles tendon combined with flap cover results in a successful and functional reconstruction.
authors: Medical Spectrum Twente, Enschede, The Netherlands.
authors: J
authors: J
authors: Soons
authors: Medical Spectrum Twente, Enschede, The Netherlands.
authors: H A
authors: HA
authors: Rakhorst
authors: University Medical Center, Groningen, The Netherlands.
authors: M
authors: M
authors: Ruettermann
authors: Erasmus Medical Center, Rotterdam, The Netherlands.
authors: A J M
authors: AJ
authors: Luijsterburg
authors: Erasmus Medical Center, Rotterdam, The Netherlands.
authors: P K
authors: PK
authors: Bos
authors: Medical Spectrum Twente, Enschede, The Netherlands.
authors: O T
authors: OT
authors: Zöphel
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000503:physiopathology; D003646:Debridement; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture; D017695:Soft Tissue Injuries / Q000601:surgery*; D013530:Surgical Wound Infection / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery; D016896:Treatment Outcome
keywords: Achilles Tendon Function; Free Flap; Infection; PROM; Plastic Surgery; Questionnaire; Rupture Achilles tendon; Tendon Reconstruction