: The Achilles tendon rupture represents one of the most common tendon ruptures. Although its primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This study aims to present our orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October 2018 and October 2020. The average soft tissue defect was 126,2 (range, 86,1-175,9 cm2) with a tendon gap of 8,2 cm (range, 7,1-10,3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure with a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using AOFAS and SF-36 questionnaire. Mean follow-up was 18,3 months (range, 12-24 months). Flap survival was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees vs. 62 degrees). The SF-36 and AOFAS scores of all patients improved significantly (p < 0.005) at 12 months of follow-up. Microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture providing a reconstructed tendon that achieves satisfactory anatomical shape and function.
GRAFT AND FLAP. A NOVEL ORTHOPLASTIC APPROACH TO ACHILLES TENDON SECONDARY RUPTURE
Maruccia, Michele;Tedeschi, Pasquale;Caizzi, Gianni;Palmiotto, Florianna;Vicenti, Giovanni;Moretti, Biagio;Giudice, Giuseppe;Elia, Rossella
2023-01-01
Abstract
: The Achilles tendon rupture represents one of the most common tendon ruptures. Although its primary repair remains the treatment of choice, surgical complications, such as secondary rupture and tendon exposure, require salvage procedures. This study aims to present our orthoplastic approach for the functional reconstruction of composite secondary Achilles tendon defects. Seven patients with chronic open wound and large Achilles tendon defects (Kuwada type IV) underwent one-stage reconstruction between October 2018 and October 2020. The average soft tissue defect was 126,2 (range, 86,1-175,9 cm2) with a tendon gap of 8,2 cm (range, 7,1-10,3 cm). A combined team of orthoplastic surgeons performed the reconstructive procedure with a turndown gastrocnemius fascial flap and a fascia lata autograft for the tendon reconstruction and a free fasciocutaneous anterolateral thigh flap for soft tissue coverage (graft and flap). Subjective evaluation and quality-of-life measures were obtained preoperatively and 12 months postoperatively using AOFAS and SF-36 questionnaire. Mean follow-up was 18,3 months (range, 12-24 months). Flap survival was 100%. Overall range of motion of the reconstructed side was 87% of the unaffected side (54 degrees vs. 62 degrees). The SF-36 and AOFAS scores of all patients improved significantly (p < 0.005) at 12 months of follow-up. Microsurgical approach combined with orthopedic techniques can solve complex cases of Achilles tendon secondary rupture providing a reconstructed tendon that achieves satisfactory anatomical shape and function.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
