title: Peroneal Tendon Reconstruction and Coverage for Treatment of Septic Peroneal Tenosynovitis: A Devastating Complication of Lateral Ankle Ligament Reconstruction With a Tendon Allograft.
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.
authors.affiliation: University Place, WA. Electronic address: vlsdpm@gmail.com.
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Schade
authors.affiliation: Chief, Otolaryngology Service, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Wayne
authors.initials: W
authors.lastname: Harsha
authors.affiliation: Staff, Adult Family Nurse Practitioner, South Sound Internal Medicine, Olympia, WA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Rodman
authors.affiliation: 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.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Roukis
mesh_terms: D000328:Adult; D064591:Allografts; D016512:Ankle Injuries / Q000601:surgery*; D054544:Arthroplasty, Subchondral; D001753:Blast Injuries / Q000601:surgery; D003646:Debridement; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000601:surgery*; D008297:Male; D008889:Military Personnel; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000628:therapy; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*; D013628:Talus / Q000293:injuries / Q000601:surgery; D013710:Tendons / Q000601:surgery / Q000637:transplantation; D013717:Tenosynovitis / Q000209:etiology / Q000382:microbiology* / Q000601:surgery
keywords: Hunter rods; peroneal tendon; reconstruction; septic peroneal tenosynovitis; tensor fascia lata