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The Anterolateral Thigh Flap for Achilles Tendon Reconstruction

Functional Outcomes

Ehrl, Denis, M.D.; Heidekrueger, Paul I., M.D.; Schmitt, Andreas, M.D.; Liska, Franz, M.D.; Ninkovic, Milomir, M.D., Ph.D.; Giunta, Riccardo, M.D., Ph.D.; Broer, P. Niclas, M.D., Ph.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1772–1783
doi: 10.1097/PRS.0000000000005652
Reconstructive: Lower Extremity: Original Article
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Coding Perspective

Background: Following Achilles tendon rupture and repair, reruptures or infections are not infrequent. Consequently, several surgical techniques have been described to decrease complication rates. This study aimed to evaluate the outcomes of the free composite fasciocutaneous anterolateral thigh flap including fascia lata for reconstruction of combined complex soft-tissue and Achilles tendon defects.

Methods: Within an 8-year period, 34 patients having undergone microvascular Achilles tendon reconstruction fulfilled inclusion criteria for this study: 25 of these patients (73.5 percent) returned for follow-up examination, seven of whom (28.0 percent) underwent additional bilateral contact pressure and power measurements. The data were screened for patients’ demographics, intraoperative and perioperative details, flap survival, surgical complications, and overall long-term outcomes.

Results: Mean follow-up time was 40.8 months. The Thompson test was negative in all patients. The pain score assessed by the Numerical Rating Scale at the reconstructed site was low overall, but showed significant differences between rest and activity (p < 0.05). The assessment of the Vancouver Scar Scale showed very good results with both techniques. The measurements of the peak pressures, power while walking, and foot contact area did not show differences between the operated and nonoperated sides (p > 0.05), whereas range of motion revealed significant differences (p < 0.05).

Conclusions: In patients who suffer complex Achilles tendon injury requiring free flap coverage, the composite anterolateral thigh flap including fascia lata provides a reliable and safe approach with very good functional and aesthetic outcomes. It should be considered one of the first reconstructive options.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Coding Perspective for this Article is on Page 1781.

Munich, Germany

From the Department of Hand, Plastic, and Aesthetic Surgery, Ludwig Maximilian University of Munich; the Department of Plastic, Reconstructive, Hand, and Burn Surgery, Bogenhausen Academic Teaching Hospital; and the Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich.

Received for publication February 28, 2018; accepted December 14, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work.

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Denis Ehrl, M.D., Department of Hand, Plastic and Aesthetic Surgery, Ludwig Maximilian University of Munich, Marcioninistrasse 15, 81377 Munich, Germany, dr.d.ehrl@gmail.com

©2019American Society of Plastic Surgeons