Reconstruction of soft tissue defects around the Achilles region with distally based extended peroneal artery perforator flap |
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| Affiliation: | 1. Acibadem Mehmet Ali Aydinlar University School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey;2. Private Practice, Plastic, Reconstructive and Aesthetic Surgery, Istanbul, Turkey;1. Foot and Ankle Research and Innovation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;2. Department of Orthopaedic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt;4. Department of Sports Medicine and Orthopaedic Surgery, University of Kansas Medical Center, KS, USA;5. Foot and Ankle Service, Hospital of Special Surgery, NY, USA;6. Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital and Newton-Wellesley Hospital, Harvard Medical School, Boston, MA, USA;1. Naval Health Research Center, 140 Sylvester Rd., San Diego, CA, 92106, USA;2. Leidos, Inc., 140 Sylvester Rd., San Diego, CA, 92106, USA;1. Orthopedic Trauma Service, Hadassah University Hospital, Jerusalem, Israel;2. Orthopedic Department, Hadassah University Hospital, Jerusalem, Israel;3. Orthopedic Department, Emek Medical Center, Afula, Israel;4. Orthopedic Department, Shaare Zedek Medical Center, Jerusalem, Israel |
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| Abstract: | IntroductionAchilles tendon rupture and soft tissue infections with wound dehiscence and tendon exposure following the tendon repair are not infrequent. Various procedures have been described for the reconstruction of soft tissue defects at the Achilles tendon region, yet there is lack of consensus on the ideal method. In this article we report our experience using the distally based peroneal artery perforator flap in reconstruction of combined defects of the Achilles tendon and overlying soft tissue.Methods7 patients with Achilles tendon injury and full-thickness soft tissue defects over the Achilles region underwent tendon repair and soft tissue reconstruction with the distally based peroneal artery perforator flap. Perforator vessels were identified at the septum between the peroneus longus and soleus muscles. After choosing the perforator with the largest diameter, meticulous deep dissection of the perforator was performed and completed 6 cm proximal to the lateral malleolus. The peroneal artery was transected and ligated and transposition of the flap to the defect was performed through a subcutaneous tunnel.ResultsThe size of the soft tissue defects and flaps ranged between 2×3 cm to 4×10 cm and 4×5 cm to 5×12 cm, respectively. Six out of 7 flaps survived completely without any complications. Post-operative venous congestion was observed in one patient which resulted in partial tip necrosis of the flap. The resulting wound healed with conservative treatment. Donor sites healed uneventfully in all patients. All flaps had excellent contour and provided stable soft tissue coverage.ConclusionDistally based peroneal artery perforator flap can be considered as a reliable alternative for the reconstruction of soft tissue defects around the Achilles tendon region. Advantages include (1) extended reach of the flap for the defects around the plantar and dorsal aspects of the foot, provided by the perforator dissection, (2) convenience with footwear and walking, provided by the skin texture similarity with the target region, (3) creating a protective surface to allow tendon gliding and prevent tissue adhesions after the tendon repair, provided by the crural fascia included in the flap, (4) obviating the need for microsurgical anastomosis and associated length of the operation. |
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