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“Repair and Flap technique”: A Retrospective Analysis of Single Stage Reconstruction Method for Treatment of Chronic Open Achilles Tendon Defect with Proximal Turndown Flap and Reverse Sural Flap

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Abstract

Background

Management of complex wounds of the lower extremity with concomitant Achilles tendon injury is a challenging situation for orthopaedic surgeons and plastic surgeons. The objective of the current study was to evaluate the clinical outcome of chronic open defects of the Achilles tendon with composite tissue loss. We have performed single stage reconstruction using the central segment of the proximal part of the Achilles tendon as turn-down flap and was covered immediately with reverse sural flap.

Materials and methods

Between March 2017 and February 2020, five cases of chronic open composite Achilles tendon defects which were treated by a single stage reconstruction method of “Repair and Flap technique” were included in this study. The patient with the defect for more than 4 weeks duration and had substance loss of Achilles tendon together with loss of overlying skin and soft tissue was included the current study.

Results

All the flaps survived and healed well, providing stable coverage of the wound. The mean operative duration, including flap elevation, definitive flap inset and donor-site coverage was 98 min (range 90–120 min). Focal areas of skin graft loss were seen in two patients which healed with conservative management. The functional results evaluation was performed with The Achilles Tendon Total Rupture Score (ATRS). The mean Achilles Tendon Total Rupture Score (ATRS) was 70 (range 65–76)

Conclusion

To conclude, use of proximal turned down flap and coverage with reverse sural flap can be opted as a first option for the management of chronic open wounds with composite defects of the Achilles tendon. “Repair and Flap technique” will be a useful method of reconstruction in centres with limited resources for microsurgical flap. However, a multicenter study with more number of patients are required to further analyse this method.

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Authors and Affiliations

  1. Plastic, Burns, Hand and Microsurgical Services, Kavin Medical Center, Erode, Tamil Nadu, 638011, India

    G. I. Nambi

  2. Department of Surgical Oncology, The Gujarat Cancer Research Institute (GCRI), Ahmedabad, Gujarat, India

    Abhijeet Ashok Salunke

  3. MM Deemed University, Ambala, India

    Subodh Pathak

  4. Divine Plastic Surgery Centre, Ahmedabad, Gujarat, India

    Harshvardhan Sahijwani & Pramod Menon

  5. Northern Joint Replacement Centre, Jalgoan, India

    Manish Chaudhari

  6. NG Teng Fong General Hospital, Singapore, Singapore

    Chen Yongsheng

  7. Department of Surgical Oncology, Gujarat Cancer Research Institute, Ahmedabad, India

    Mayur Kamani

  8. Shree Krishna Hospital, Anand, India

    Prashant Moon

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  1. G. I. Nambi
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  2. Abhijeet Ashok Salunke
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Correspondence to Abhijeet Ashok Salunke.

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Nambi, G.I., Salunke, A.A., Pathak, S. et al. “Repair and Flap technique”: A Retrospective Analysis of Single Stage Reconstruction Method for Treatment of Chronic Open Achilles Tendon Defect with Proximal Turndown Flap and Reverse Sural Flap. JOIO 55 (Suppl 1), 149–156 (2021). https://doi.org/10.1007/s43465-020-00278-1

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  • DOI: https://doi.org/10.1007/s43465-020-00278-1

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