Arch Plast Surg.  2019 May;46(3):267-271. 10.5999/aps.2018.00066.

Achilles tendon reconstruction with a half-width Achilles graft and wrap-around fascial flap

• Prasetyono TOH
• Sisca F

• KMID: 2450938
• DOI: http://doi.org/10.5999/aps.2018.00066

Abstract

A 70-year-old man complained imbalance while walking, inability to perform ankle flexion, and could not stand on tip-toe 3 months after injury. The ankle looked swollen with loss of Achilles contour and obvious gait disturbance. Magnetic resonance imaging shows a 5-cm Achilles tendon gap. Subsequently, surgery was performed to solve the neglected Achilles tendon rupture. Patient was put under general anesthesia with a regional block. Using a non-tourniquet technique, a reconstructive procedure was performed using a half-width autologous Achilles tendon graft, which was attached to the calcaneal prominence with wire in a double strand Bunnell fashion. As for the proximal stump, double core Bunnell/modified Kessler suturing was carried out to suture the graft to Achilles stump. To increase the vascularization, an ipsilateral gastrocnemius fascial flap with a distally based-pedicle was harvested to wrap around the tendon graft. At a 6-month follow-up, the patient was able to stand on tip-toe and had also regained a normal gait.

Keyword

Achilles tendon; Gait; Reconstructive surgical procedures; Tourniquets

MeSH Terms

Achilles Tendon*
Aged
Anesthesia, General
Ankle
Follow-Up Studies
Gait
Humans
Magnetic Resonance Imaging
Reconstructive Surgical Procedures
Rupture
Sutures
Tendons
Tourniquets
Transplants*
Walking