Reconstructing and resurfacing open neglected Achilles tendon injury by distal posterior tibial artery perforator based adipofascial flap

Chirurgia plastica - Tập 27 - Trang 196-199 - 2004
A. Mohanty1,2, P. Jain1
1Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 5, India
2c/o U.N. Mohanty, Friends’ Colony, Cuttack, India

Tóm tắt

Surgical management of open neglected Achilles tendon injury and damaged overlying skin is very demanding. Here, we report a case of 50 year-old man who sustained an injury to the left Achilles tendon causing complete disruption of the tendon with an open wound. The patient came to us after 3 months and was managed by tendon debridement, reconstruction by the Bosworth method, and resurfacing with a distal posterior tibial artery perforator based turn-over adipofascial flap covered with a split thickness skin graft. There was minimal skin graft loss which healed by itself. A 9 month follow up of the reconstructed tendon showed a good functional result and a normal range of dorsi and plantar flexion of the foot. This technique provides an easy and quick solution to resurface the tendoachilles with minimal donor site morbidity.

Tài liệu tham khảo

Azar FM, Pickering RM (1998) Traumatic Disorders. In: Canale ST (ed) Campbell’s operative orthopaedics Vol, 2, 9th edn. Mosby Year Book, St. Louis, pp1413–1422 Babu NV, Chittaranjan S, Abraham G, Bhattacharjee S, Korula RJ (1994) Vascularised extensor digitorium brevis to reconstruct Achilles tendon: a case report. Acta Orthop Scand 65:101–102 Deiler S, Pfadenhauer A, Widmann J, Stutzle H, Kanz K, Stock W (2000) Tensor fascia latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularised fascia. Plast Reconstr Surg 106:342–349 Dumont CE, Kersler J (2001) A composite medial plantar flap for the repair of an Achilles’ tendon defect: a case report. Ann Plast Surg 47:666–668 El-Khatib H (1996) Island adipofascial flap for resurfacing of the Achilles tendon. Plast Reconstr Surg 98:1034–1038 Lai CS, Lin SD, Yang CC, Chou CK (1991) Adipofascial turnover flap for reconstruction of the dorsum of the foot. Br J Plast Surg 44:170–174 Lee S, Estela CM, Burd A (2001) The lateral distally based adipofascial flap of the lower limb. Br J Plast Surg 54:303–309 Lin SD, Lai CS, Chou CK, Tsai CW (1992) The distally based posterior tibial arterial adipofascial flap. Br J Plast Surg 45:284–287 Paavola M, Orava S, Leppilahti J et al (2000) Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med 28:77–82 Sylaidis P, Fatah MFT (1995) A composite lateral arm flap for the secondary repair of a multiply ruptured Achilles tendon. Plast Reconstr Surg 96:1719–1723 Termolada C, Candiani P, Colonna M, Stefani A, Donati L (1994) Questions and tips for the use of adipo (fascial) subcutaneous turnover flaps in electric burn wounds. Plastic Reconstr Surg 94:217–218 Thatte RL, Laud N (1998) Deepithelialized “turnover” skin flap of the lower leg and foot. In: Strauch B, Vasconez LO, Hall-Findlay EJ (eds) Grabb’s Encyclopedia of Flaps, vol 3, , 2nd edn. Lippincott, Philadelphia, pp1825–1830