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The presence of combined tendocutaneous defect of Achilles tendon has made surgical reconstruction complex and challenging, owing to a lack of suitable local tissues. [1] Both the soft tissue coverage and tendon reconstruction must be considered to achieve a good functional and aesthetic outcome.A simple Achilles tendon rupture can be managed with primary tendon repair, [2] while a segmental loss of Achilles tendon requires a more sophisticated procedures to restore its continuity. There is a great diversity of surgical techniques to Achilles tendon defects described in the literature, including tendon transfer (flexor hallucis longus [FHL], semitendinosus, peroneus brevis or hamstring tendon), percutaneous techniques (figure-of-eight stitch repair or modified Combined tendocutaneous defect of Achilles tendon remains a complex reconstructive challenge whereby both the soft tissue coverage and tendon reconstruction have to be considered to achieve a good functional and aesthetic outcome. A 14-year-old boy who sustained an open right calcaneum fracture (Gustilo-Anderson IIIB) with a transected Achilles tendon and huge skin defect from motorcycle wheel spoke injury was admitted. The Achilles tendon repair site broke down following initial surgical debridement and primary repair, resulting in a sizeable combined tendocutaneous defect. Simultaneous soft tissue coverage and tendon defect reconstruction using composite sensate free anterior lateral thigh (ALT) fasciocutaneous flap with vascularized fascia lata was performed subsequently. The vascularized fascia lata was tubularized to wrap the native proximal stump of Achilles tendon and secured using the modified Krakow suturing technique. The distal end of tubularized fascia lata was, then, secured by drilling across right calcaneum bone, passing the suture transosseously and screwed. He led an uneventful postoperative recovery with satisfactory functional and aesthetic outcomes at one year of follow-up. In conclusion, the present case demonstrates the reliability of this technique and its advantages over other flap choices in reconstruction of a huge combined tendocutaneous defect.

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