Dorsalis Pedis Artery-based Flap to Cover Nonhealing Wounds over the Tendo Achillis—A Case Series

Abstract

Background/Purpose Soft tissue necrosis after the repair of a ruptured tendo Achillis is a difficult problem commonly encountered by orthopaedic surgeons. Such wounds are difficult to manage because of the tenuous blood supply and the characteristic anatomical features of the area. Flaps such as the reverse sural flap, medial plantar flap, gastrocnemius flap and free flaps cover such wounds with a good success rate. The aim of our study was to investigate the use of a dorsalis pedis artery (DPA)-based flap to cover a wound over the tendo Achillis insertion area. Methods We report a series of 11 patients in whom wounds over the tendo Achillis insertion area were covered with a DPA-based flap. Between 1995 and 2012, 11 patients (nine men and two women), who were referred to us with a nonhealing wound over the tendo Achillis because of soft tissue necrosis after the open repair of a ruptured tendon, were selected for soft tissue coverage of the wound by using a DPA-based flap. Results The average follow-up period was 2.4 years (range, 1–6 years). The mean operative time was 1.7 hours (range, 1.5–2.0 hours). At the latest follow-up examination, the flaps had survived in all patients. Conclusion A DPA-based flap is a good and relatively less complex procedure to use to cover defects over the tendo Achillis with minimum donor site morbidity.

Different Modalities of Flap Coverage of Achilles Tendon Region Defects: Functional and Aesthetic Outcomes

“…However, according to literature, muscle flaps and myocutaneous flaps are definitely not the best choice to cover Achilles' tendon because of the bulky and prone to adhesion with the underlying tendon. In addition, reverse sural flaps offer a good alternative for resurfacing soft tissue defects over the Achilles tendon region [12] .…”