One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment

The combined loss of the Achilles tendon with overlying soft tissue is a reconstructive challenge. To achieve acceptable rehabilitation, such patients need skin coverage including functional repair of the Achilles tendon. This article presents four such patients who were treated successfully by means of an anterolateral thigh (ALT) composite flap with vascularized fascia lata. The size of the ALT flaps ranged from 10 to 16 cm in length and 6 to 9 cm in width. All flaps included vascularized fascia lata, which was rolled to serve as vascularized tendon graft (range 8 x 6 cm to 10 x 8 cm) for reconstruction of the Achilles tendon defect. Flap success rate was 100%. All patients could walk and climb stairs without support; however, mild difficulty when running was reported. Functional outcome of the recipient ankle and donor thigh morbidity were investigated by using a kinetic dynamometer comparing reconstructed sides with the healthy contralateral limbs. This assessment was performed in two patients at 2 years postoperatively. In the reconstructed ankles, isokinetic concentric measurements of dorsiflexion and plantar flexion showed a deficit of 30% and 40%, respectively. Functional evaluation of quadriceps femoris muscle contraction forces after free ALT composite flap harvest showed a 10% to 25% deficit. However, there were no difficulties in daily ambulating. In summary, the free composite ALT flap with vascularized fascia lata provides an alternative option for Achilles tendon reconstruction in complex defects.