title: The composite anterolateral thigh flap for achilles tendon and soft tissue defect reconstruction with tendon repair by fascia with double or triple folding technique.
abstract: BACKGROUND
  Rupture of the Achilles tendon is usually managed by surgical intervention. Recurrent tendon ruptures, segmental tendon defects, and overlying soft tissue defects render reconstructive procedures challenging. In this report, we present double or triple folding technique of the anterolateral thigh (ALT) free flap, and report the clinical outcomes of the reconstruction of combined defects, including the Achilles tendon and overlying soft tissue.
  
  
  METHODS
  From 2008 to 2013, 7 patients underwent reconstruction of combined Achilles tendon and soft tissue defects. The sizes of the soft tissue defects ranged from 9 × 5 to 12 × 5 cm(2) . Combined defects were reconstructed with ALT free flap including the vastus lateralis fascia and rectus femoris fascia, using a double or triple folding technique. The ALT free flap covered the soft tissue defect and the fascia was folded two or three times into a tendon-like structure. Three patients had full-layer defects of the Achilles tendon, and four patients had partial defects over half the layer.
  
  
  RESULTS
  The dimension of the skin paddle of the ALT flap was 12 × 6 to 16 × 8 cm(2), and the dimension of the fascia was 12 × 8 to 16 × 10 cm(2). All the donor sites were closed primarily. All the flaps survived completely without complication. The mean follow-up period was 14.9 months. All patients were able to stand and ambulate.
  
  
  CONCLUSIONS
  The double or triple folding technique of the ALT free flap represents simple, economical use of tissue, with minimal donor site morbidity. Thus, this technique may be useful and versatile reconstructive option for combined defects.
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Seung Ki
authors.initials: SK
authors.lastname: Youn
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea.
authors.forename: Sang Wha
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Youn Hwan
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: Kyu Tae
authors.initials: KT
authors.lastname: Hwang
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000601:surgery; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture / Q000601:surgery; D017695:Soft Tissue Injuries / Q000601:surgery*; D013708:Tendon Injuries / Q000601:surgery*; D013848:Thigh; D016896:Treatment Outcome