Journal of Japanese Society of Reconstructive Microsurgery
Online ISSN : 2185-9949
Print ISSN : 0916-4936
ISSN-L : 2185-9949
Case Report
Re-Reconstruction of the Achilles Tendon Using an Anterolateral Thigh Flap with the Vastus Lateralis in a Dialysis Patient
Hiroshi YAMAMOTO
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2020 Volume 33 Issue 3 Pages 156-160

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Abstract

The Achilles tendon of a 48-year-old male patient became infected following tendon repair. He was a compromised host with pyodermatitis of unknown cause who underwent dialysis and had taken oral corticosteroids for polyarteritis nodosa. He was infected with Pseudomonas aeruginosa and lost a large amount of soft tissue, including the Achilles tendon, after several rounds of debridement. After the infection was controlled, he received an anterolateral thigh flap with vascularized tensor fascia lata and vastus lateralis muscle. For recurrent infection, he received daily irrigation and repeated debridement with local gentamicin injections. Seven months after the flap surgery, he was able to walk without difficulty and there was no recurrence of infection. Strategic management is important for infection of the extremities, especially in compromised hosts, because local infections may spread to other tissues. Saucerization and debridement are the first choice to reduce the number of bacteria. Flap surgeries should be considered under aseptic conditions to reconstruct the tissue defects. A few antibiotics should be used at a high dose for a short period to prevent the evolution of antibiotic-resistant bacteria. An ALT flap with the vascularized fascia lata and vastus lateralis was suggested to be effective to reconstruct the Achilles tendon and to control infection.

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© 2020 Japanese Society of Reconstructive Microsurgery
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