One-Stage Reconstruction of an Infected Skin and Achilles Tendon Defect with a Composite Distally Planned Lateral Arm Flap

Berthe, Jean-Valéry; Toussaint, D; Coessens, Bruno-Christophe

doi:10.1097/00006534-199810000-00044

Cited by 59 publications

(44 citation statements)

References 23 publications

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“…Various flaps have been described including the inferiorly based pedicled flap, reverse sural flap, islanded pedicled flaps, perforator flaps, propeller flaps and free flaps. [3][4][5][6][7][8][9][10][11]22 Free flaps are suitable for more extensive trauma, major avulsions and long defects, the procedure needs advanced skills, instrumentation, equipment and prolonged operating time. For moderate sized defects and majority of cases local flaps serve the purpose.…”

Section: Discussionmentioning

confidence: 99%

“…Various flaps have been described in literature for cover over TA like distally based skin flaps, advancement flap, free tissue transfers and islanded flaps. [3][4][5][6][7][8][9][10][11] The advent of islanded propeller flaps has changed the approach to reconstruction in general. Presence of abundance of perforators in the lower third of the leg arising from the posterior tibial and peroneal vessels is well documented.…”

Section: Introductionmentioning

confidence: 99%

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Propellar flap: safe, reliable option for coverage of exposed tendo achilles

2018

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Background: Stable skin cover over exposed tendo achilles is absolutely essential for proper healing and recovery of tendo achilles function. Exposed tendo achilles can be a result of open injuries, repair of closed TArupture, complications after repair like suture dehiscence, skin necrosis, infection, delayed exposure and recurrent rupture. Various methods have been described for coverage of repaired tendo achilles like distally based skin flaps, advancement flap, free tissue transfers and islanded flaps. This study describes the usefulness of islanded propeller flap for stable skin cover over tendo achilles.Methods: Over a period of 4 years from March 2012 to August 2016 with total cases were 6, all male patients between 16 to 56 years of age were included in the study. Method of tendo achilles repair/reconstruction was planned, based on individual case requirement. All patients underwent islanded propeller flap for coverage of exposed tendo achilles. All cases were followed up for at least 1 year.Results: All flaps except one case survived and on follow up the function of tendo achilles was excellent with stable, supple, healthy skin overlying the tendon. Tendoachilles strength was assessed by asking the patient to stand on toes.Conclusions: Islanded propeller flap cover over tendoachilles provides a stable, reliable, single stage procedure with good aesthetic appearance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Propellar flap: safe, reliable option for coverage of exposed tendo achilles

2018

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“…In severe cases, reconstruction is required with a flap and many types have been described. [6][7][8][9][10][11][12] Paramedian incisions lie directly over the tendon. The risk of exposure of the tendon is high in the event of wound complications.…”

Section: Discussionmentioning

confidence: 99%

A new incision for surgery on tendo Achillis using a distally-based fasciocutaneous flap

Chana

Chen

Jain

2002

The Journal of Bone and Joint Surgery. British volume

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he consequences of breakdown of the wound after surgery to tendo Achillis are considerable. Complex surgery is often required to reconstruct the tendon and to provide soft-tissue cover. We describe a new incision which approaches the tendon by using a distally-based fasciocutaneous flap. This reduces the risk of breakdown of the wound since it avoids making an incision directly over the tendon, provides good exposure, and maintains the vascularity of the skin overlying the tendon. The current, preferred surgical approach to tendo Achillis is a longitudinal incision, either on its medial or lateral side. 1,2 There is, however, a risk of breakdown of the wound because of poor vascularity of the skin in this region. As it heals the tendon lies directly beneath the incision. The potential complication is skin loss with exposure and necrosis of the tendon. We describe an approach to tendo Achillis which uses the principle of a distally-based fasciocutaneous flap in order to avoid making an incision too close to the tendon. Patients and MethodsOperative technique. A distally-based fasciocutaneous flap is raised with the vertical limbs just posterior to each malleolus. The transverse limb is made above the tendinous portion of gastrocnemius (Fig. 1). Since this is a randompattern fasciocutaneous flap, the ratio of the length to width is kept to a maximum of 3:1.3 The flap is raised in the subfascial plane in order to achieve exposure of the tendon (Fig. 2). On the lateral side, care must be taken to ensure T that the sural nerve is not damaged. Closure of the skin is achieved using 4-0 vicryl subcuticular dermal sutures with the knots buried and 4-0 nylon for the skin. In tendonlengthening procedures with a chronic plantar flexion deformity, deficiency of skin may require either a full-thickness graft from the groin, or a split-thickness graft from the thigh (Fig. 3). Illustrative case reportsCase 1. A 51-year-old man presented with a rupture of the right tendo Achillis sustained while playing basketball one week earlier. He underwent surgery using a distally-based fasciocutaneous flap and the tendon was repaired with 2/0 prolene. He had an uneventful postoperative recovery. At the follow-up at six months he was fully mobile, although he had a slightly hypertrophic scar at the medial malleolus. Case 2. A 45-year-old man presented with a rupture of his left tendo Achillis which he had sustained one month earlier.He underwent surgery using a distally-based fasciocutaneous flap and the tendon was repaired with 2/0 prolene. His postoperative recovery was uneventful. Seven months after surgery the scar had healed and he was walking normally. Case 3. A 25-year-old man had suffered a crush injury to his right foot and ankle ten years earlier which had remained untreated. He presented with a plantar flexion deformity of his right foot and was only able to walk on tiptoe. Examination revealed a shortened and contracted tendo Achillis. Radiographs revealed no bony abnormality. He underwent surgery to lengthen the tendon. An inci...

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“…B. der Suralislappen, oder freie Lappen aus der oberen Extremität, z. B. der laterale Oberarmlappen ("composite lateral arm flap") [3,27] bzw. der Radialis-palmaris-longus-composite-Lappen ("radial forearm-palmaris longus composite free flap") [12].…”

Section: Möglichkeiten Zur Sekundären Achillessehnenrekonstruktionunclassified