Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue

Abstract

Purpose: Defect of Achilles tendon and overlying soft tissue remains a surgical challenge due to its insufficient blood supply and high requirement of function. This study aims to report the clinical efficacy of the composite sural neurocutaneous composite flap with gastrocnemius tendon on the complicated defect of Achilles region. Methods: Seven cases of defects of Achilles tendon and overlying soft tissue were reconstructed by the composite sural neurocutaneous composite flaps with gastrocnemius tendons. It is important to keep the connection between gastrocnemius tendon and deep fascia of the composite flap during operation. The smallest and the largest areas of transferred skin flaps were 7.5 cm × 4.5 cm and 11 cm × 10 cm respectively. The size of gastrocnemius tendon ranged from 5 cm × 3 cm to 9 cm × 4 cm. Patients was evaluated by using the Arner-Lindholm scale at the last follow-up. Results: Six flaps survived completely with no complication. One flap developed wound dehiscence and went on to heal by daily dressing. With 12–60 months follow-up, all patients gained satisfactory appearance and function of ankle, without tendon re-rupture or recurrent infection. Based on Arner-Lindholm scale, six cases were noted to be excellent and one was good. Conclusion: The composite sural neurocutaneous flap with gastrocnemius tendon is a viable and practical method to salvage Achilles tendon defect and overlying soft tissue coverage, with minimal adhesion and satisfactory function.

Efficacy of two different types of island flaps for the repair of diabetic foot ulcers on the heel

“…In addition, the SNNAIF flap is most commonly used for the clinical repair of heel wounds (15,16). Its blood is supplied by the anastomotic branches between the most distal septal perforating branch of the peroneal artery and the sural nerve nutrition blood vessel.…”

Reconstruction of chronic tibialis anterior tendon ruptures using a free anterior half of a peroneus longus tendon autograft: A technical note

“…4 A delay in the diagnosis of TA tendon rupture may result in a major tendon defect, making a direct repair no longer suitable. 5,6 Several techniques have been introduced to reconstruct the TA tendon rupture, which include the use of an allograft tendon, an autogenous tendon such as the EDL, plantaris or hamstring tendons, or an EHL tendon transfer. [1][2][3][4]7,8 Although satisfactory clinical outcomes have been reported with the use of an autogenous tendon, there is still a possibility of donor site morbidity after full-thickness tendon harvest.…”