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
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:
Vol. 17 No. 1, April 2009 Reconstruction of the Achilles tendon and overlying