Single-Stage Bipedicle Local Tissue Transfer and Skin Graft for Achilles Tendon Surgery Wound Complications.
BACKGROUND
Achilles tendon and posterior heel wound complications are difficult to treat. These typically require soft tissue coverage via microvascular free tissue transfer at a tertiary referral center. Here, we describe coverage of a series of posterior heel and Achilles wounds via simple, local tissue transfer, called a bipedicle fasciocutaneous flap. This flap can be performed by an orthopaedic foot and ankle surgeon, without resources of tertiary/specialized care or microvascular support.


METHODS
Three patients with separate pathologies were treated with a single-stage bipedicle fasciocutaneous local tissue transfer. Case 1 was a patient with insertional wound breakdown after Achilles debridement and repair to the calcaneus. Case 2 was a heel venous stasis ulcer with calcaneal exposure in a diabetic patient with vasculopathy. Case 3 was a patient with wound breakdown following midsubstance Achilles tendon repair. All three cases were treated with a single-stage bipedicle local tissue transfer for posterior ankle and heel wound complications.


RESULTS
All 3 patients demonstrated complete healing of the posterior defect, lateral ankle skin graft recipient site, and the skin graft donor site after surgery. Case 3 had a subsequent recurrent ulceration after initial healing. This was superficial and healed with local wound care. All patients regained full preoperative range of motion and were able to ambulate independently without modified footwear.


CONCLUSIONS
The bipedicled fasciocutaneous flap described here offers a predictable single stage procedure that can be accomplished by an orthopaedic foot and ankle surgeon without resources of a tertiary care center for posterior foot and ankle defects. This flap can be performed with short operative times and can be customized to facilitate defect coverage. The flap is durable to withstand local tissue stresses required for early ambulation. Despite its reliability, patients require careful follow-up to manage underlying comorbid conditions that may complicate wound healing.


METHODS
Level IV: Case series.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Travis J
TJ
Dekker
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Yash
Y
Avashia
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Suhail K
SK
Mithani
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Andrew P
AP
Matson
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Alexander J
AJ
Lampley
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Samuel B
SB
Adams
D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006365:Heel / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D014945:Wound Healing
Achilles tendon; bipedicle; complication; surgery; tissue transfer; wound