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J Reconstr Microsurg 2018; 34(08): 632-641
DOI: 10.1055/s-0038-1660830
Original Article: WSRM 2017 Scientific Paper
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Predictors of Clinical Outcome after Reconstruction of Complex Soft Tissue Defects Involving the Achilles Tendon with the Composite Anterolateral Thigh Flap with Vascularized Fascia Lata

Zaher Jandali   *
1   Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
,
Martin C. Lam   *
1   Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
,
Benedikt Merwart
1   Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
,
Bernd Möhring
2   Department of Orthopedics, Rehabilitation Center Oldenburg, Institute of Sport Sciences, University of Oldenburg, Oldenburg, Germany
,
Stephanie Geil
3   Department of Physical Therapy, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
,
Klaus Müller
4   Department of Plastic, Aesthetic and Reconstructive Surgery, Asklepios Klinik Barmbek, Asklepios Medical School, Hamburg, Germany
,
Mihai Ionac
5   Department of Vascular Surgery and Reconstructive Microsurgery, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
,
Lucian P. Jiga   *
1   Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, Evangelisches Krankenhaus Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
› Author Affiliations
Further Information

Publication History

11 January 2018

29 April 2018

Publication Date:
26 June 2018 (online)

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Abstract

Background The composite anterolateral thigh flap with vascularized fascia lata (ALT-FL flap) for covering complex soft tissue defects involving the Achilles tendon has shown promising results. The age and body mass index (BMI) are important predictors of clinical outcome after surgical treatment of Achilles tendon ruptures. In this study, we investigate whether these also influence the outcome of patients after Achilles tendon reconstruction using the ALT-FL flap.

Methods Twenty patients (mean age: 55.9 ± 8.7 years) with complex tissue defects involving the Achilles tendon underwent reconstruction with the ALT-FL flap. Both the Achilles tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed preoperatively and 12 months postoperatively. In addition, postoperative magnetic resonance imaging (MRI) studies and measurements of the ankle range of motion were performed and results compared with existing literature.

Results All flaps survived and MRI studies confirmed complete anatomical integration of the fascia lata as “neotendon” at the recipient site. In our patient cohort, the age did not correlate with the outcome measurements, whereas the BMI showed significant negative correlation with the postoperative ATRS (p < 0.001) and AOFAS scores (p < 0.05). The ATRS and AOFAS scores of all patients improved significantly (p < 0.001). However, obese patients with a BMI of more than 30 kg/m2 achieved significant lower ATRS (p < 0.001) and AOFAS scores (p < 0.01), as well as patients with peripheral artery disease (PAD) (p < 0.05). The mean ankle range of motion after ALT-FL flap reconstruction remained statistical insignificant compared with previous avascular or vascularized tendon repairs of the Achilles tendon.

Conclusion The ALT-FL flap enables reconstruction of complex tissue defects involving the Achilles tendon with good functional results. However, the presence of an increased BMI or PAD, but not necessarily the age, proves to be a predictor of poor clinical outcome and therefore should be subject to scrutiny during patient selection.

Keywords

Achilles tendon reconstruction - vascularized tendon repair - anterolateral thigh flap with fascia lata

* The first two authors contributed equally to this work.