Simultaneous Reconstruction of Achilles Tendon and Soft-Tissue Defects with a Composite Anterolateral Thigh Free Flap with Vascularized Fascia Lata.

INTRODUCTION: Reconstruction to treat segmental loss of the Achilles tendon combined with soft-tissue defects can be challenging, particularly after the recurrent ruptures that may occur during intense physical activity. STEP 1 PREOPERATIVE PLANNING: Design flap and use Doppler ultrasound for perforator mapping. STEP 2 DEBRIDE WOUND AND PREPARE RECIPIENT VESSELS: Use a two-team approach, one for the affected side and one for the unaffected side. STEP 3 HARVEST THE COMPOSITE ALT FLAP: Take care to include one or two perforator vessels in the flap and to avoid vessel damage throughout the dissection. STEP 4 PERFORM VASCULAR ANASTOMOSIS: Use the posterior tibial vessel as the recipient site for the microvascular anastomosis. STEP 5 RECONSTRUCT THE ACHILLES TENDON: Suture the rolled up vascularized fascia lata sheet; then check for tension. STEP 6 POSTOPERATIVE CARE: Gradual, protected weight-bearing begins at twelve weeks. RESULTS & PREOP/POSTOP IMAGES: For recurrent tendon rupture, this single-step reconstruction saves both time and expense and it provides a functional tendon reconstruction (enabling normal daily activities) with limited donor-site morbidity and an acceptable cosmetic result without the need for a later debulking procedure. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.