Reconstruction of the Achilles tendon and overlying soft tissue using an anteromedial thigh flap for a post-burn pes equinus deformity: a case report

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Reconstruction of the Achilles tendon and overlying soft tissue using an anteromedial thigh flap for a post-burn pes equinus deformity: a case report Powered By Docstoc
					Journal of Orthopaedic Surgery 2009;17(1):116-8




Reconstruction of the Achilles tendon and
overlying soft tissue using an anteromedial
thigh flap for a post-burn pes equinus
deformity: a case report
T Naganawa, Y Ohno, K Ohnishi, K Shimizu
Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan




                                                                CASE REPORT

ABSTRACT                                                        In April 2003, a 36-year-old man presented with
                                                                a severe pes equinus ankle deformity and an
We present a 36-year-old man with a severe pes                  intractable ulcer over the Achilles tendon (Fig. 1) after
equinus deformity of the ankle and an intractable               a 4th-degree burn 3 years earlier. He had undergone
ulcer over the Achilles tendon after a 4th-degree               several skin grafting procedures in another hospital.
burn. He underwent a one-stage reconstructive                   His ankle dorsiflexion was limited to -30º.
surgical procedure using an anteromedial thigh                       A one-stage reconstructive surgical procedure
flap with its vascularised fascia. After lengthening            was planned using a vascularised iliotibial band and
of the Achilles tendon and posterior release of the             a free anterolateral thigh flap. It aimed to achieve (1)
ankle, the anteromedial thigh fasciocutaneous flap              correction of the pes equinus deformity, lengthening
was transferred. The ischaemic Achilles tendon was              of the Achilles tendon, and posterior ankle release; (2)
wrapped with the vascularised femoral fascia for                reconstruction of the degenerated Achilles tendon; and
vascularisation and reinforcement. The skin defect              (3) skin flap coverage. Intra-operatively, the Achilles
was covered with the skin paddle of the combined                tendon was found to be dull, thin, degenerated,
flap. There were no postoperative complications. At             and poorly vascularised (Fig. 2). After debridement
the 3-year follow up, the range of movement of the              of the granulation tissue, the Achilles tendon was
ankle was almost normal. The patient was able to                lengthened in a Z fashion. The pes equinus deformity
walk and climb stairs without support, and the ulcer            was corrected after posterior release of the ankle joint.
was cured.                                                      Upon elevation of the flap, the lateral descending
                                                                branch of the lateral circumflex femoral artery was
Key words: Achilles tendon; burns; reconstructive surgical      found to have no reliable perforators to the skin.
procedures; surgical flaps; thigh                               The flap was changed to an anteromedial thigh flap.
                                                                On flap elevation, the thigh fascia was harvested


Address correspondence and reprint requests to: Dr Toshitaka Naganawa, 1-1 Yanagido Gifu City Gifu, 501-1194, Japan. E-mail:
naganawa7777777@yahoo.co.jp
Vol. 17 No. 1, April 2009               Reconstruction of the Achilles tendon and overlying 
				
DOCUMENT INFO
Description: We present a 36-year-old man with a severe pes equinus deformity of the ankle and an intractable ulcer over the Achilles tendon after a 4th-degree burn. He underwent a one-stage reconstructive surgical procedure using an anteromedial thigh flap with its vascularised fascia. After lengthening of the Achilles tendon and posterior release of the ankle, the anteromedial thigh fasciocutaneous flap was transferred. The ischaemic Achilles tendon was wrapped with the vascularised femoral fascia for vascularisation and reinforcement. The skin defect was covered with the skin paddle of the combined flap. There were no postoperative complications. At the 3-year follow up, the range of movement of the ankle was almost normal. The patient was able to walk and climb stairs without support, and the ulcer was cured. [PUBLICATION ABSTRACT]
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