J Reconstr Microsurg 2008; 24(2): 127-130
DOI: 10.1055/s-2008-1076090
© Thieme Medical Publishers

A Single-Stage Reconstruction of a Complex Achilles Wound with Modified Free Composite Lateral Arm Flap

Cheol-Hann Kim1 , Min-Seong Tark1 , Chang-Yong Choi1 , Sang-Gue Kang1 , Yong-Bae Kim1
  • 1Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University, Seoul, Korea
Further Information

Publication History

Publication Date:
29 April 2008 (online)

ABSTRACT

Composite defect of the posterior aspect of the heel, including the Achilles tendon, usually is very difficult to reconstruct as we face the problems of controlling infection, resurfacing the deficient skin defect, and restoring plantar flexion. With the latest advances in microsurgery, several free composite flaps have been used to reconstruct the defect in the Achilles tendon region to achieve stable and functional soft tissue coverage. We report such a single-stage reconstruction of a complex Achilles wound using the modified neurosensory lateral arm free flap including the triceps tendon strip and the posterior cutaneous nerve. Authors' rolled-up triceps tendon strip method is presented for the one-stage reconstruction of the Achilles tendon and soft tissue defect, providing good contour, strong tension, and protective sensation. The follow-up has proved a satisfactory outcome.

REFERENCES

  • 1 Haas F, Seibert F J, Koch H et al.. Reconstruction of combined defects of the Achilles tendon and the overlying soft tissue with a fascia lata graft and a free fasciocutaneous lateral arm flap.  Ann Plast Surg. 2003;  51 376-382
  • 2 Kim S W, Hong J P, Lee W J et al.. Single-stage Achilles tendon reconstruction using a composite sensate free flap of dorsalis pedis and tendon strips of the extensor digitorum longus in a complex wound.  Ann Plast Surg. 2003;  50 653-657
  • 3 Lee J W, Yu J C, Shieh S J, Liu C, Pai J J. Reconstruction of the Achilles tendon and overlying soft tissue using antero-lateral thigh free flap.  Br J Plast Surg. 2000;  53 574-577
  • 4 Wei F C, Chen H C, Chuang C C et al.. Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region.  Plast Reconstr Surg. 1988;  81 579-589
  • 5 Inoue T, Tanaka I, Imai K et al.. Reconstruction of Achilles tendon using vascularised fascia lata with free lateral thigh flap.  Br J Plast Surg. 1990;  43 728-731
  • 6 Isenberg J S, Fusi S. Immediate Achilles' tendon reconstruction with composite palmaris longus grafts.  Ann Plast Surg. 1995;  34 209-211
  • 7 Waris T H, Kaarela O I, Raatikainen T K et al.. Microvascular flaps from the lateral arm and radial forearm for the repair of defects of the Achilles tendon region.  Scand J Plast Reconstr Surg Hand Surg. 1991;  25 87-89
  • 8 Nelson J M, Dobke M K. Achilles tendon reconstruction with the extended temporoparietal-galeal flap.  Worldplast. 1995;  2 129-134
  • 9 Lidman D, Nettelblad H, Berggren A et al.. Reconstruction of soft tissue defects including the Achilles tendon with free neurovascular tensor fascia lata flap and fascia lata.  Scand J Plast Reconstr Surg Hand Surg. 1987;  21 213-218
  • 10 Lee H B, Lew D H, Oh S H et al.. Simultaneous reconstruction of the Achilles tendon and soft-tissue defect using only a latissimus dorsi muscle free flap.  Plast Reconstr Surg. 1999;  104 111-119
  • 11 Babu V, Chittaranjan S, Abraham G et al.. Single-stage reconstruction of soft-tissue defects including the Achilles tendon using the dorsalis pedis arterialized flap along with the extensor digitorum brevis as bridge graft.  Plast Reconstr Surg. 1994;  93 1090-1094
  • 12 Katsaros J, Tan E, Zoltie N et al.. Further experience with the lateral arm free flap.  Plast Reconstr Surg. 1991;  87 902-910
  • 13 Berthe J V, Toussaint D, Coessens B C. One-stage reconstruction of an infected skin and Achilles tendon defect with a composite distally planned lateral arm flap.  Plast Reconstr Surg. 1998;  102 1618-1622

Min-Seong TarkM.D. 

Department of Plastic and Reconstructive Surgery, College of Medicine, Soon Chun Hyang University Hospital

657, Hannam-dong, Yongsan-gu, Seoul, 420-767, Korea

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