Abstract
Background: Reconstruction of Achilles tendon and the overlying tissue
defects is a challenging undertaking. The spectrum of available repair
methods range from secondary healing to use of free flaps. Method: In
this study, we retrospectively evaluated 14 patients who underwent
reconstruction of Achilles region defect between 2016 and 2019 at a
single center. Results: Reconstructions were performed with secondary
healing (n=2), negative pressure wound therapy and skin grafting (n=2),
free flaps (n=6), and local and distant flaps (n=4). Satisfactory
aesthetic and functional outcomes were achieved in all patients. One
patient developed partial skin graft loss. Marginal necrosis occurred in
one of the local flaps. Wound dehiscence and flap retraction occurred in
one of the free (superficial circumflex iliac artery perforator) flaps.
One patient undergoing reconstruction with ulnar artery perforator flap
developed intraoperative atrial fibrillation; the operation was
terminated and reconstruction completed with skin grafting. Conclusion:
Orthoplastic reconstruction should be kept in mind for Achilles tendon
defects. Use of special digital imaging techniques facilitates flap
surgery and helps minimize the risk of flap complications. Conventional
approaches are suitable for shallow small skin lesions. Local flaps are
good options for deeper skin defects owing to superior aesthetic
outcomes. Superthin free flaps offer a distinct advantage in skillful
hands. Use of multi-content free chimeric flaps for reconstruction of
complex defects facilitates better anatomical repair. Cross leg or
flow-through flaps may be considered in patients with compromised distal
circulation. Selection of the most reliable approach for Achilles
reconstruction is a key imperative to achieve favorable outcomes.