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http://dx.doi.org/10.5999/aps.2018.00066

Achilles tendon reconstruction with a half-width Achilles graft and wrap-around fascial flap  

Prasetyono, Theddeus Octavianus Hari (Division of Plastic Surgery, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia)
Sisca, Fransisca (Faculty of Medicine Universitas Indonesia)
Publication Information
Archives of Plastic Surgery / v.46, no.3, 2019 , pp. 267-271 More about this Journal
Abstract
A 70-year-old man complained imbalance while walking, inability to perform ankle flexion, and could not stand on tip-toe 3 months after injury. The ankle looked swollen with loss of Achilles contour and obvious gait disturbance. Magnetic resonance imaging shows a 5-cm Achilles tendon gap. Subsequently, surgery was performed to solve the neglected Achilles tendon rupture. Patient was put under general anesthesia with a regional block. Using a nontourniquet technique, a reconstructive procedure was performed using a half-width autologous Achilles tendon graft, which was attached to the calcaneal prominence with wire in a double strand Bunnell fashion. As for the proximal stump, double core Bunnell/modified Kessler suturing was carried out to suture the graft to Achilles stump. To increase the vascularization, an ipsilateral gastrocnemius fascial flap with a distally based-pedicle was harvested to wrap around the tendon graft. At a 6-month follow-up, the patient was able to stand on tip-toe and had also regained a normal gait.
Keywords
Achilles tendon; Gait; Reconstructive surgical procedures; Tourniquets;
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