Published: 2022-10-28

Microvascular cutaneous coverage in wounds that expose the Achilles tendon: case report

Penelope J. Haquet-Guerrero, Rodrigo Banegas-Ruiz, Hector A. Morales-Yépez, Eric Contreras-Sibaja, Daniel Pichardo-Esquivel, Luis M. Hernández-García, Paúl Robledo-Madrid, Julián O. Ibarra-López, Julio O. Rodriguez-Bautista, Nadia A. Rodriguez-García, Miguel Á. Canseco-Fuentes, Erik A. Torre-Anaya


Achilles tendon rupture, being one of the main tendon ruptures present, surgery being the most favourable option even taking into account complications such as infections and skin necrosis, it is necessary to develop techniques which help to reduce complications and increase benefits. The methods follow-up of 2 cases of patients with skin defects in the region of the Achilles tendon in patients who were treated at the "Luis Guillermo lbarra lbarra" national rehabilitation institute during the period 2020-2021 in the Traumatology service, treated with radial free flap forearm, using the description of the most used flaps in the literature. Results in both cases integrity of the free radial forearm flap in its entirety, functional recovery for walking, ability to put shoes back on, and without the need for reoperation, as well as a high level of satisfaction by patients. Conclusions if we are talking about an Achilles tendon rupture with a significant skin defect, the free radial forearm flap is an adequate option, if we are talking about a complete defect, the composite flap is the best option, remember that the decision on what type of flap will be used will depend on of the size of the lesion.


Tendon rupture, Achilles tendon, Radial flap, Microsurgery

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Yang X, Meng H, Quan Q, Peng J, Lu S, Wang A. Management of acute Achilles tendon ruptures: a review. None Joint Res. 2018;561-9.

Innocenti M, Innocenti A, Ghezzi S, Delcroix L. Achilles region soft tissue defects: a reconstructive algorithm based on a series of 46 cases. J Reconstr Microsurg. 2017;40-47.

Seung-Hwan P, Ho Seong L, Ki Won Y, Sang Gyo S. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg. 2020;12(1):1-8.

Del Buono A, Chan O, Maffulli N. Achilles tendon: functional anatomy and novel emerging models of imaging classification. International Orthopaedics (SICOT). 2013;37:715-21.

Jandali Z, Lam M, Merwart B, Mohring B, Geil S, Muller K et al. 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. J Reconstr Microsurg. 2018;632-4.

Huttunen TT, Kannus P, Rolf C, Tsai L, Mattila V. Acute Achilles tendon ruptures: incidence of injury and surgery in Sweden between 2001 and 2012. Am J Sports Med. 2014;2419-23.

Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 1993;791-9.

Deng S, Sun Z, Zhang C, Chen G, Li J. Surgical treatment versus conservative management for acute Achilles tendon rupture: a systematic review and meta-analysis of randomized controlled trials. J Foot anke surg. 2017;1236-43.

Ozkaya U, Parmaksizoglu AS, Kabukcuoglu Y, Sokucu S, Basilgan S. Open minimally invasive Achilles tendon repair with early rehabilitation: functional results of 25 consecutive patients. Injury. 2009;669-72.

Houtmeyers P, Opsomer D, Van Landuyt K, Monstrey S. Reconstruction of the Achilles tendon and overlying soft tissue by free composite anterolateral thigh flap with vascularized fascia lata. J Reconstr Microsurg. 2012;205-9.

Dun R. Grafts and Flaps. Surgery. 2006;27-32.

Nazerali R, Hakimi M, Giza E. Sahar D. Single-stage reconstruction of Achilles tendon rupture with flexor hallucis longus tendon transfer and simultaneous free radial fasciocutaneous forearm flap. Ann Plast Surg. 2013;416-8.

Innocenti M, Tani M, Carulli C, Ghezzi S, Raspanti A, Menichini G. Radial forearm flap plus flexor carpi radialis tendon in Achilles Tendon reconstruction: Surgical Technique, functional results, and gait analysis. Microsurgery. 2015;608-14.

Cheol-Hann K, Min-Seong T, Chang-Yong C, Sang-Gue K, Yong-Bae K. A single-stage reconstruction of a complex Achilles wound with modified free composite lateral arm flap. J Reconstr microsurg. 2008;127-30.

Ehrl D, Heidekrueger P, Schmitt A, Liska F, Ninkovic M, Giunta R et al. The anterolateral thigh flap for Achilles Tendon reconstruction: Functional Outcomes. Plast Reconstr Surg. 2019;1772-83.

DeFazio M, Han K, Lorio M, Attinger C, Steinberg J, Kim P et al. Combined free tissue transfer for the Management of Composite Achilles defects: functional outcomes and patient satisfaction following thigh-based vascularized reconstruction with a neo tendon construct. J Reconstr Microsug. 2014;431-40:36.

Jakubietsz R, Jakubietz D, Gruenert J, Schmidit R, Meffert R, Jakubietz M. Reconstruction of soft tissue defects of the Achilles tendon with rotation flaps, pedicled propeller flaps and free perforator flaps. Microsurgery. 2010;608-13.