Abstract
Introduction: Soft tissue defects with exposed Achilles tendon is common in trauma. Surgically covering these defects by fasciocutaneous flap can preserve normal function of the Achilles tendon. Various methods have been described and reported in the literatures: local advancement flap, region flap, or free flap. The purpose of this article is to report the results of 10 cases who were operated to cover the Achilles tendon by perforator V-Y advancement flap, discuss the indications and advantages of using this flap.
Patients and methods: A retrospective study describes 10 cases: 8 males and 2 females, aged from 4 to 71. The patients had soft tissue defect with expose Achilles tendon who were operated cover by V-Y advancement flap based on perforator of peroneal artery from 07/2018 to 05/2021. Follow-up time from 3 months to 3 years.
Results: The size of defect is from 3×2 cm to 8×6 cm. The size of flap is from 3,5x4cm to 16×6 cm. All 10/10 flaps were total survival and completely cover the defect. All patients preserved normal function of the Achilles tendon.
Conclusions: Using the V-Y advancement flap based on perforator of peroneal artery to cover the soft tissue defect with expose Achilles tendon had good results, restore normal function with good aesthetic.
Keywords: V-Y advancement flap, Island perforator flap, Achille tendon coverage, Exposed Achille tendon.
References
- Bharat SS, Dutta G, Bhattacharya R. Reconstruction of soft tissue defect of the Achilles tendon with islanded V-Y advancement flap. International Journal of Surgery Science 2020;4(4):73-75
- Babu V, Chittaranjan S, Abraham G, Korula RJ. 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;93:1090-4.
- Leppilahti J, Kaarela O, Teerikangas H, Raatikainen T, Orava S, Waris T. Free tissue coverage of wound complications following Achilles tendon rupture surgery. Clin Orthop 1996;328:171-6.
- Barron JN,Emmett AJJ. Subcutaneous pedicle flaps. Br J Plast Surg,18(1965), pp.51-78
- Rad AN, Singh NK, Rosson GD. Peroneal artery perforator-based propeller flap reconstruction of the lateral distal lower extremity after tumor resection. Microsurg 2008;28:663-70.
- Attinger CE, Ducic I, Hess C. Outcome of skingraft versus flap surgery in the salvage of the exposed Achilles tendon in diabetics versus nondiabetics. Plast Reconstr Surg 2006;117:2460.
- Jakubietz RG, Kloss DF, Gruenert JG, Jakubietz MG. The 180-degree perforator-based propeller flap for soft tissue coverage of the distal lower extremity: a new method to achieve reliable coverage of the distal lower extremity with local perforator flap. Ann Plast Surg 2007;59:667-671.
- Erdmann MW, Court-Brown CM, Quaba AA. A five-year review of islanded distally based fasciocutaneous flaps on the lower limb. Br J Plast Surg 1997;50:421-427.
- Omokawa S, Yajima H, Tanaka Y, Ryu J. Long term results of lateral calcaneal artery flap for hind foot reconstruction. J Reconstr Mircrosurg 2008;24:239-245.
- Tran Xuan Thach, Bui Mai Anh, Dao An Giang, Nguyen Thi Thu Hang, Nguyen Hong Ha. Pinwheel flap: Flexible materials for repair of soft tissue defect. Journal Journal of the Vietnam orthopaedic associatio 2016:301-305
- Lee JW, Yu JC, Shieh SJ, Liu C, Pai JJ. Reconstruction of the Achilles tendon and overlying soft tissue using ALT free flap. Br J Plast Surg 2000;53:574-7.
- Berthe JV, Toussaint D, Coessens BC. One-stage reconstruction of an infected skin and Achilles tendon defect with a composite distally planned lateral arm flap. Plast Re-constr Surg 1998;102:1618-22.
- Deiler S, Pfadenhauer A, Widmann J, Stuutzle H, Kanz KG, Stock W. Tensor fasciae latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularized fascia. Plast Reconstr Surg 2000;106:342-9.
- el-Khatib H. Island adipofascial flap for resurfacing of the Achilles tendon. Plast Reconstr Surg 1996;98:1034-8.
- Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir 2002;34:251-6.
- Nguyen Moc Son. Evaluating the results of surgical treatment for total rupture of Achilles tendon due to trauma at Viet Duc University Hospital. Medical Residency thesis. Hanoi Medical University