Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis.
BACKGROUND
Wound dehiscence, infection, and necrosis of tendon and overlying skin are severe complications after open repairs of Achilles tendon. A simultaneous reconstruction should be provided in a single stage operation. We evaluated the outcomes of one of the possible options: the radial forearm free flap with Flexor Carpi Radialis (FCR) tendon.


METHODS
Between 2006 and 2014, six patients affected by infection and necrosis after Achilles tendon open repair underwent multi-tissutal reconstruction by a composite radial forearm free flap including a vascularized FCR tendon. The mean skin and tendon defect was respectively 9.8 cm × 4.7 cm and 6.5 cm. After reconstruction, patients underwent clinical examination, including the Achilles Tendon Total Rupture Score (ATRS) questionnaire, DASH score, MRI study, and a computer-assisted gait analysis.


RESULTS
All flaps survived and no complications were recorded. Full weightbearing was allowed within 2 months after surgery. The mean follow-up was 36.2 months (range 12-96). MRI showed an optimal reconstruction of the tendon. Range of motion was minimally reduced if compared to the contralateral side. Gait analysis showed the recovery of a nearly symmetrical stance phase, time to heel off, and step length of the gate. ATRS and DASH score improved to a mean value of 85.2 (range 83-88) and 8.0 (range 3-15) respectively.


CONCLUSIONS
This procedure provided an anatomical reconstruction of the Achilles tendon and skin achieving good and objective functional results; donor site morbidity was limited to the sacrifice of the radial artery, which, in our opinion, is a minor drawback if compared to the quality of the results.
Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Marco
M
Innocenti
Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Massimiliano
M
Tani
Orthopaedic Clinic, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Christian
C
Carulli
Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Serena
S
Ghezzi
Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Andrea
A
Raspanti
Plastic Surgery and Reconstructive Microsurgery Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Giulio
G
Menichini
D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000601:surgery*; D058752:Free Tissue Flaps / Q000637:transplantation*; D005684:Gait; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture / Q000601:surgery; D013530:Surgical Wound Infection / Q000503:physiopathology / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome