Reconstruction of Infected Skin and an Achilles Tendon Defect with a Composite Free Anterolateral Thigh Flap and Vascularized Fascia Lata tissue

Abstract

Achilles tendon defects associated with infection and skin defects are not uncommon. The three main problems that have to be addressed when treating such defects include the control of local infections, the provision of soft tissue coverage, and the restoration of ankle plantar flexion. The reconstruction of such wounds using conventional methods usually involves multiple procedures, and the functional results are not always satisfactory. We present a case involving segmental loss of the Achilles tendon associated with infection and the loss of skin and the surrounding soft tissue. The patient was successfully managed using a composite anterolateral thigh flap and vascularized fascia lata tissue. He was able to walk without any support at 16 postoperative weeks. At the latest follow-up ( at 2 postoperative years ), he exhibited a normal gait and was able to walk without pain and fatigue. He was also able to stand on his tiptoes and displayed normal plantar flexion strength. The combined use of an anterolateral thigh flap along with vascularized fascia lata tissue represents a useful option for the reconstruction of complex Achilles tendon defects.