The Anterolateral Thigh Flap for Achilles Tendon Reconstruction: Functional Outcomes

Abstract

Background: Following Achilles tendon rupture and repair, reruptures or infections are not infrequent. Consequently, several surgical techniques have been described to decrease complication rates. This study aimed to evaluate the outcomes of the free composite fasciocutaneous anterolateral thigh flap including fascia lata for reconstruction of combined complex soft-tissue and Achilles tendon defects. Methods: Within an 8-year period, 34 patients having undergone microvascular Achilles tendon reconstruction fulfilled inclusion criteria for this study: 25 of these patients (73.5 percent) returned for follow-up examination, seven of whom (28.0 percent) underwent additional bilateral contact pressure and power measurements. The data were screened for patients’ demographics, intraoperative and perioperative details, flap survival, surgical complications, and overall long-term outcomes. Results: Mean follow-up time was 40.8 months. The Thompson test was negative in all patients. The pain score assessed by the Numerical Rating Scale at the reconstructed site was low overall, but showed significant differences between rest and activity (p < 0.05). The assessment of the Vancouver Scar Scale showed very good results with both techniques. The measurements of the peak pressures, power while walking, and foot contact area did not show differences between the operated and nonoperated sides (p > 0.05), whereas range of motion revealed significant differences (p < 0.05). Conclusions: In patients who suffer complex Achilles tendon injury requiring free flap coverage, the composite anterolateral thigh flap including fascia lata provides a reliable and safe approach with very good functional and aesthetic outcomes. It should be considered one of the first reconstructive options. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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

“…[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. 33,34 Dobke et al 35 reported satisfactory outcomes of the extended temporoparietal fasciagaleal flap for a long-term follow-up.…”

“…Defects of the Achilles tendon and overlying soft tissue are not infrequent, and the reconstruction of the complex defects is still Challenging. 1,2 Bicycle and motorcycle wheel spoke injury often result in the complex defect at the Achilles tendon region, especially in children. 3,4 The Achilles tendon is the most easily ruptured tendon, and surgery is a commended solution.…”

“…Repairing the combined loss of Achilles tendon and overlying integument must maintain the stability and durability of skin and guarantee enough strength and mobility of Achilles tendon. There are many reconstructive strategies reported for this area, such as anterolateral thigh flap, 2 temporoparietal fascial flap, 10 reverse sural artery flap 11 and propeller flaps 12,13 based on posterior tibial artery perforator or peroneal artery perforator. Each approach has its own drawbacks and the adequate treatment is still controversial.…”

The vascularized fascia lata free flap: an anatomical study and clinical considerations

“…The ALT flap is mainly harvested as fasciocutaneous free flap incorporating fascia lata (FL), overlying adipose tissue and skin, or as myocutaneous flap with additional muscular component to increase bulk [5][6][7]. The FL as fascial component of the ALT flap is preferred particularly for tendon reconstruction of lower and upper limbs [8,9]. In addition, the FL is routinely used as non-vascularized graft in anterior skull base surgery or rhinology to cover small skull base defects.…”

Performing Distance Measurements in Curved Facial Regions: A Comparison between Three-Dimensional Surface Scanning and Ultrasound Imaging

“…1 While some of the defects resulting from such tumor extirpation can be closed by simple, intermediate, or complex repair, a large number result in tissue deficits that require flap reconstruction. [2][3][4][5][6] Flap design depends on a plethora of factors; however, initial surgical planning always needs to ensure proper vascularization and blood supply of the flap. 7 Ultrasound imaging is a commonly used tool to visualize the course of vessels prior to surgery and to facilitate the planning…”