Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

Abstract

Reconstruction to treat segmental loss of the Achilles tendon combined with soft-tissue defects can be challenging, particularly after the recurrent ruptures that may occur during intense physical activity. Design flap and use Doppler ultrasound for perforator mapping. Use a two-team approach, one for the affected side and one for the unaffected side. Take care to include one or two perforator vessels in the flap and to avoid vessel damage throughout the dissection. Use the posterior tibial vessel as the recipient site for the microvascular anastomosis. Suture the rolled up vascularized fascia lata sheet; then check for tension. Gradual, protected weight-bearing begins at twelve weeks. For recurrent tendon rupture, this single-step reconstruction saves both time and expense and it provides a functional tendon reconstruction (enabling normal daily activities) with limited donor-site morbidity and an acceptable cosmetic result without the need for a later debulking procedure. IndicationsContraindicationsPitfalls & Challenges.