Back to Search Start Over

Graft and Flap: Orthoplastic Approach to Achilles Tendon Secondary Rupture.

Authors :
Maruccia M
Tedeschi P
Caizzi G
Palmiotto F
Di Summa PG
Vicenti G
Moretti B
Giudice G
Elia R
Source :
Plastic and reconstructive surgery [Plast Reconstr Surg] 2023 Dec 01; Vol. 152 (6), pp. 1359-1364. Date of Electronic Publication: 2023 Apr 25.
Publication Year :
2023

Abstract

Summary: Achilles tendon rupture represents one of the most common tendon ruptures. Although primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This article aims to present the authors' orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open-wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October of 2018 and October of 2020. The size of the average soft-tissue defect was 126.2 cm 2 (range, 86.1 to 175.9 cm 2 ), with a tendon gap of 8.2 cm (range, 7.1 to 10.3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure, using a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft-tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using the American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey questionnaire. Mean follow-up was 18.3 months (range, 12 to 24 months). The flap survival rate was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees versus 62 degrees). The American Orthopedic Foot and Ankle Score and 36-Item Short-Form Health Survey scores of all patients improved significantly ( P < 0.005) at 12 months of follow-up. A microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture, providing a reconstructed tendon that achieves satisfactory anatomic shape and function.<br />Clinical Question/level of Evidence: Therapeutic, IV.<br /> (Copyright © 2023 by the American Society of Plastic Surgeons.)

Details

Language :
English
ISSN :
1529-4242
Volume :
152
Issue :
6
Database :
MEDLINE
Journal :
Plastic and reconstructive surgery
Publication Type :
Academic Journal
Accession number :
37092978
Full Text :
https://doi.org/10.1097/PRS.0000000000010566