Free flap reconstruction of Achilles tendon and overlying skin defect using ALT and TFL fabricated chimeric flap

Ando, Junji; Sakuraba, Minoru; Sugawara, Atsushi; Goto, Aya; Azuma, Shinya; Mitsuhashi, Nobuyuki; Sasaki, Kousuke; Sone, Itaru

doi:10.1080/23320885.2019.1635023

Cited by 12 publications

(16 citation statements)

References 10 publications

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“…Neurotization was described in four studies; connections included the posterior cutaneous nerve to the sural nerve branch 18 19 24 or tibial nerve 19 and the lateral femoral cutaneous nerve to the saphenous nerve. 25 Suture technique was only mentioned in three studies, with techniques including Kirchmayer's, 4 Krackow, 10 Figure of 8, 6 and Becker. 6 Operative time for composite flaps was mentioned in six studies, with an average time of 326.7 minutes (SD 23.1).…”

Section: Resultsmentioning

confidence: 99%

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

Sayyed

Bekeny

Day

et al. 2022

J Reconstr Microsurg

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Background Tendon rupture with extensive soft tissue loss has few reconstructive options. Composite free tissue transfers including skin and tendon offer an attractive reconstructive approach. Unfortunately, most studies discussing them come from sparse case reports. We systematically assess evidence supporting composite flap use in single-stage reconstruction of lower extremity tendon and soft tissue defects. Methods A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. OvidMEDLINEqueried for records pertaining to the study question using Medical Subject Heading (MeSH) terms such as “lower extremity,” “tendon,” and “composite flap.” No limitations were placed on the year of publication, country of origin, or study size. Study characteristics and patient demographics were collected. Primary outcomes included:(1) defect location, composite flap characteristics;(2) return to ambulation;(3) joint range of motion;(4) patient satisfaction, and (5) complications. Results In total, 29 articles examining 173 patients with lower extremity tendon defects and soft tissue loss were identified. Average age was 44.3 years (SD 17.5); most patients were male (n = 110, 66.3%). Achilles defect was mostly reported (n = 151, 86.8%), followed by patellar (n = 17, 9.8%) and other tendon defects (n = 6, 3.4%). Average tendon defect size was 8.4 cm (SD 4.0), average soft tissue loss was 80.2 cm2 (SD 40.0). Most employed composite flap was anterolateral thigh and fascia lata (ALT + FL) (n = 101, 58.0%). Most patients (n = 134, 99.3%) returned to ambulation in an average 123.1 days (SD 78.3). Average reconstructive joint degree of motion was 62.1 degrees compared with normal degree of motion 62.3 degrees. Patient-reported outcomes demonstrated increased satisfaction after reconstruction. Conclusion Composite flaps effectively reconstruct a variety of tendon and soft tissue defects; the most reported flap is ALT + FL, which provides large flap territories and rapid healing in Achilles, patellar, and other tendon defects. In this review, patients with composite flaps demonstrated return to ambulation, minimal impairment in range of motion, and notable postoperative satisfaction.

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Section: Resultsmentioning

confidence: 99%

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

Sayyed

Bekeny

Day

et al. 2022

J Reconstr Microsurg

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“…Excising a long tendinous muscle flap can also reconstuct the dynamic defect of the foot and ankle. For example, Ando et al 30 . applied ALT and TFL fabricated chimeric flaps to reconstruct Achilles tendon and overlaying skin defects successfully.…”

Section: Discussionmentioning

confidence: 99%

“…Excising a long tendinous muscle flap can also reconstuct the dynamic defect of the foot and ankle. For example, Ando et al 30 applied ALT and TFL fabricated chimeric flaps to reconstruct Achilles tendon and overlaying skin defects successfully. However, it is necessary to obtain the multi-leaf flap and muscle flap during the operation, which increases the time to separate the nutrient vessels and the risk of necrosis of the muscle flap.…”

Section: Chimeric Anterolateral Thigh Perforator Flap For Large Soft Tissue Defects Of Foot and Anklementioning

confidence: 99%

Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap

Zeng

Yuan³

et al. 2021

Orthopaedic Surgery

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Objective: To evaluate the clinical application and surgical efficacy of the chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap for the reconstruction of the large area of deep wound in foot and ankle.Methods: Clinical data of 32 cases who underwent chimeric anterolateral thigh perforator flap to repair the large area of deep wound of the foot and ankle from January 2015 to December 2018 were retrospectively analyzed. The sizes of the defects ranged from 18 cm Â 10 cm to 35 cm Â 20 cm, with exposed tendon and bone and/or partial defects and necrosis, contaminations, accompanied by different degrees of infection. Following the radical debridement and VSD, chimeric anterolateral thigh perforator flap was employed to repair the deep wounds according to the position, site and deep-tissue injury of the soft-tissue defects. The skin flap and muscle flap were fanned out on the wound, and single-or two-staged split-thickness skin grafting was performed on the muscle flap. The operation time and blood loss were recorded. The survival and healing conditions of the operational site with chimeric anterolateral thigh perforator flap were evaluated post-operationally. Complications at both recipient site and donor site were carefully recorded. Results:The mean time of the operation was 325.5 min and average blood loss was 424.8 mL. Among the 32 cases, two cases developed vascular crisis, which were alleviated with intensive investigation and treatment; Four cases suffered from partial necrosis of the flap or skin graft on the muscle flap or on the residual local wound, which were improved after treatment of further dressing change and skin grafting. Another four cases experienced post-traumatic osteomyelitis accompanied by bone defect were treated with simple bone grafting or Mesquelet bone grafting at 6-8 months after wound healing. Postoperatively, the wounds were properly healed, and the infection was effectively controlled without sinus tract forming. Overall, all 32 cases received satisfactory efficacy, without influencing subsequent functional reconstruction, and observed infection during the 12-36 months post-operational follow-up. Conclusion:The chimeric perforator flap pedicled with the descending branch of the lateral circumflex femoral artery and the lateral thigh muscle flap provides an effective and relative safe procedure for the repair of a large area of deep wound in the foot and ankle, particularly with irregular defect or deep dead space.

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“…29 The composite anterolateral thigh flap with the fascia lata has been widely applied in Achilles region, especially in massive deficit. [30][31][32] There are some unignorable drawbacks including vascular crisis, secondary thinning procedures for bulky flap and deficit of quadriceps femoris muscle contraction forces. 2,31 The radial forearm flap with palmaris longus tendon provides thin and pliable integument and long tendon, while it has significant donorsite morbidity and is better suited for small rather than massive defects.…”

Section: Discussionmentioning

confidence: 99%

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

Zhou

Wei

Tao

et al. 2020

J Orthop Surg (Hong Kong)

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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.

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Free flap reconstruction of Achilles tendon and overlying skin defect using ALT and TFL fabricated chimeric flap

Abstract: A 33-year-old man developed a left Achilles tendon rupture and skin necrosis. We reconstructed the defect using an anterolateral thigh flap and a tensor fasciae lata muscle flap in a chimeric fashion. he was able to stand on a toe of the operated foot without help 6 months postoperatively.

Cited by 12 publications

References 10 publications

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

Composite Free Tissue Transfer for Reconstruction of Lower Extremity Tendon Injuries: A Systematic Review

Reconstruction of Large Area of Deep Wound in the Foot and Ankle with Chimeric Anterolateral Thigh Perforator Flap

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

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