Bipedicled Flap for the Reconstruction of Soft Tissue Defects of the Achilles Tendon

Chin-Ta Lin, Shyi-Gen Chen, Tim-Mo Chen, Niann-Tzyy Dai, Shun-Cheng Chang

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. The purpose of this article was to present our experience of 11 patients who underwent reconstruction of soft tissue defects of the Achilles tendon using bipedicled fasciocutaneous flaps. Between August 2008 and August 2012, 11 patients were admitted to our hospital, presenting with soft tissue defects overlying the Achilles tendon. After adequate debridement, the 11 patients underwent bipedicled fasciocutaneous flap placement to resurface the complex soft tissue defects and provide a gliding surface for the exposed Achilles tendon. The patients' age, comorbidity, etiology, defect size and location, wound culture, skin graft size, complications, surgery duration, and follow-up period were reviewed. The 11 fasciocutaneous bipedicled flaps survived completely, and the wounds healed satisfactorily at a mean follow-up period of 20.9 months (range, 6-48 months). Only 1 flap was complicated with wound dehiscence and superficial necrosis of its lateral edge, which healed conservatively. The donor sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or elderly patients. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. Thus, the bipedicled fasciocutaneous flap can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.
Original languageEnglish
Pages (from-to)484-487
Number of pages4
JournalAnnals of Plastic Surgery
Volume74
Issue number4
DOIs
Publication statusPublished - 2015
Externally publishedYes

Fingerprint

Achilles Tendon
Wounds and Injuries
Transplants
Early Ambulation
Skin
Pressure Ulcer
Recovery of Function
Debridement
Operative Time
Vascular Diseases
Blood Vessels
Comorbidity
Necrosis
Tissue Donors
Health

Keywords

  • Achilles tendon
  • bipedicled flap
  • soft tissue defect
  • achilles tendon
  • adult
  • aged
  • case report
  • evaluation study
  • female
  • follow up
  • human
  • injuries
  • male
  • middle aged
  • plastic surgery
  • procedures
  • surgical flaps
  • Tendon Injuries
  • treatment outcome
  • vascularization
  • Achilles Tendon
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Reconstructive Surgical Procedures
  • Surgical Flaps
  • Treatment Outcome

Cite this

Bipedicled Flap for the Reconstruction of Soft Tissue Defects of the Achilles Tendon. / Lin, Chin-Ta; Chen, Shyi-Gen; Chen, Tim-Mo; Dai, Niann-Tzyy; Chang, Shun-Cheng.

In: Annals of Plastic Surgery, Vol. 74, No. 4, 2015, p. 484-487.

Research output: Contribution to journalArticle

Lin, Chin-Ta ; Chen, Shyi-Gen ; Chen, Tim-Mo ; Dai, Niann-Tzyy ; Chang, Shun-Cheng. / Bipedicled Flap for the Reconstruction of Soft Tissue Defects of the Achilles Tendon. In: Annals of Plastic Surgery. 2015 ; Vol. 74, No. 4. pp. 484-487.
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abstract = "Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. The purpose of this article was to present our experience of 11 patients who underwent reconstruction of soft tissue defects of the Achilles tendon using bipedicled fasciocutaneous flaps. Between August 2008 and August 2012, 11 patients were admitted to our hospital, presenting with soft tissue defects overlying the Achilles tendon. After adequate debridement, the 11 patients underwent bipedicled fasciocutaneous flap placement to resurface the complex soft tissue defects and provide a gliding surface for the exposed Achilles tendon. The patients' age, comorbidity, etiology, defect size and location, wound culture, skin graft size, complications, surgery duration, and follow-up period were reviewed. The 11 fasciocutaneous bipedicled flaps survived completely, and the wounds healed satisfactorily at a mean follow-up period of 20.9 months (range, 6-48 months). Only 1 flap was complicated with wound dehiscence and superficial necrosis of its lateral edge, which healed conservatively. The donor sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or elderly patients. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. Thus, the bipedicled fasciocutaneous flap can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically. Copyright {\circledC} 2014 Wolters Kluwer Health, Inc. All rights reserved.",
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author = "Chin-Ta Lin and Shyi-Gen Chen and Tim-Mo Chen and Niann-Tzyy Dai and Shun-Cheng Chang",
note = "Export Date: 21 March 2016 CODEN: APCSD 通訊地址: Chang, S.-C.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Rd, Taiwan 參考文獻: Kneser, U., Bach, A.D., Polykandriotis, E., Delayed reverse sural flap for staged reconstruction of the foot and lower leg (2005) Plast Reconstr Surg, 116, pp. 1910-1917; Hallock, G.G., Utility of both muscle and fascia flaps in severe lower extremity trauma (2000) J Trauma, 48, pp. 913-917; Jackson, I.T., Scheker, L., Muscle and myocutaneous flaps on the lower limb (1982) Injury, 13, pp. 324-330; Makhlouf, M.V., Obermeyer, Z., Bipedicle flap for wounds following Achilles tendon repair (2008) Plast Reconstr Surg, 121, pp. 235e-236e; Chang, S.M., Zhang, F., Xu, D.C., Lateral retromalleolar perforator-based flap: Anatomical study and preliminary clinical report for heel coverage (2007) Plast Reconstr Surg, 120, p. 697; Wei, F.C., Chen, H.C., Chuang, C.C., Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region (1988) Plast Reconstr Surg, 81, pp. 579-589; Berthe, J.V., Toussaint, D., Coessens, B.C., One-stage reconstruction of an infected skin and Achilles tendon defect with a composite distally planned lateral arm flap (1998) Plast Reconstr Surg, 102, pp. 1618-1622; Lee, H.B., Lew, D.H., Oh, S.H., Simultaneous reconstruction of the Achilles tendon and soft-tissue defect using only a latissimus dorsi muscle free flap (1999) Plast Reconstr Surg, 104, pp. 111-119; Lee, J.W., Yu, J.C., Shieh, S.J., Reconstruction of the Achilles tendon and overlying soft tissue using antero-lateral thigh free flap (2000) Br J Plast Surg, 53, pp. 574-577; Yuen, J.C., Nicholas, R., Reconstruction of a total Achilles tendon and soft-tissue defect using an Achilles allograft combined with a rectus muscle free flap (2001) Plast Reconstr Surg, 107, pp. 1807-1811; Papp, C., Todoroff, B.P., Windhofer, C., Partial and complete reconstruction of Achilles tendon defects with the fasciocutaneous infragluteal free flap (2003) Plast Reconstr Surg, 112, pp. 777-783; Inoue, T., Tanaka, I., Imai, K., Reconstruction of Achilles tendon using vascularised fascia lata with free lateral thigh flap (1990) Br J Plast Surg, 43, pp. 728-731; Gonzalez, M.H., Tarandy, D.I., Troy, D., Free tissue coverage of chronic traumatic wounds of the lower leg (2002) Plast Reconstr Surg, 109, pp. 592-600; Michlits, W., Gruber, S., Windhofer, C., Reconstruction of soft tissue defects overlying the Achilles tendon using the super extended abductor hallucis muscle flap (2008) J Trauma, 65, pp. 1459-1462; Quaba, O., Quaba, A., Pedicled perforator flaps for the lower limb (2006) Semin Plast Surg, 20, pp. 103-111; Erdmann, M.W., Court-Brown, C.M., Quaba, A.A., A five-year review of islanded distally based fasciocutaneous flaps on the lower limb (1997) Br J Plast Surg, 50, pp. 421-427; Babu, V., Chittaranjan, S., Abraham, G., Single-stage reconstruction of soft-tissue defects including the Achilles tendon using the dorsalis pedis arterialized flap along with the extensor digitorum brevis as bridge graft (1994) Plast Reconstr Surg, 93, pp. 1090-1094; Yang, Y.L., Lin, T.M., Lee, S.S., The distally pedicled peroneus brevis muscle flap anatomic studies and clinical applications (2005) J Foot Ankle Surg, 44, pp. 259-264; Koshima, I., Ozaki, T., Gonda, K., Posterior tibial adiposal flap for repair of wide, full-thickness defect of the Achilles tendon (2005) J Reconstr Microsurg, 21, pp. 551-554; Jakubietz, R.G., Kloss, D.F., Gruenert, J.G., The 180 degree perforator based propeller flap for soft tissue coverage of the distal lower extremity: A new method to achieve reliable coverage of the distal lower extremity with local perforator flap (2007) Ann Plast Surg, 59, pp. 667-671",
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TY - JOUR

T1 - Bipedicled Flap for the Reconstruction of Soft Tissue Defects of the Achilles Tendon

AU - Lin, Chin-Ta

AU - Chen, Shyi-Gen

AU - Chen, Tim-Mo

AU - Dai, Niann-Tzyy

AU - Chang, Shun-Cheng

N1 - Export Date: 21 March 2016 CODEN: APCSD 通訊地址: Chang, S.-C.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Rd, Taiwan 參考文獻: Kneser, U., Bach, A.D., Polykandriotis, E., Delayed reverse sural flap for staged reconstruction of the foot and lower leg (2005) Plast Reconstr Surg, 116, pp. 1910-1917; Hallock, G.G., Utility of both muscle and fascia flaps in severe lower extremity trauma (2000) J Trauma, 48, pp. 913-917; Jackson, I.T., Scheker, L., Muscle and myocutaneous flaps on the lower limb (1982) Injury, 13, pp. 324-330; Makhlouf, M.V., Obermeyer, Z., Bipedicle flap for wounds following Achilles tendon repair (2008) Plast Reconstr Surg, 121, pp. 235e-236e; Chang, S.M., Zhang, F., Xu, D.C., Lateral retromalleolar perforator-based flap: Anatomical study and preliminary clinical report for heel coverage (2007) Plast Reconstr Surg, 120, p. 697; Wei, F.C., Chen, H.C., Chuang, C.C., Reconstruction of Achilles tendon and calcaneus defects with skin-aponeurosis-bone composite free tissue from the groin region (1988) Plast Reconstr Surg, 81, pp. 579-589; Berthe, J.V., Toussaint, D., Coessens, B.C., One-stage reconstruction of an infected skin and Achilles tendon defect with a composite distally planned lateral arm flap (1998) Plast Reconstr Surg, 102, pp. 1618-1622; Lee, H.B., Lew, D.H., Oh, S.H., Simultaneous reconstruction of the Achilles tendon and soft-tissue defect using only a latissimus dorsi muscle free flap (1999) Plast Reconstr Surg, 104, pp. 111-119; Lee, J.W., Yu, J.C., Shieh, S.J., Reconstruction of the Achilles tendon and overlying soft tissue using antero-lateral thigh free flap (2000) Br J Plast Surg, 53, pp. 574-577; Yuen, J.C., Nicholas, R., Reconstruction of a total Achilles tendon and soft-tissue defect using an Achilles allograft combined with a rectus muscle free flap (2001) Plast Reconstr Surg, 107, pp. 1807-1811; Papp, C., Todoroff, B.P., Windhofer, C., Partial and complete reconstruction of Achilles tendon defects with the fasciocutaneous infragluteal free flap (2003) Plast Reconstr Surg, 112, pp. 777-783; Inoue, T., Tanaka, I., Imai, K., Reconstruction of Achilles tendon using vascularised fascia lata with free lateral thigh flap (1990) Br J Plast Surg, 43, pp. 728-731; Gonzalez, M.H., Tarandy, D.I., Troy, D., Free tissue coverage of chronic traumatic wounds of the lower leg (2002) Plast Reconstr Surg, 109, pp. 592-600; Michlits, W., Gruber, S., Windhofer, C., Reconstruction of soft tissue defects overlying the Achilles tendon using the super extended abductor hallucis muscle flap (2008) J Trauma, 65, pp. 1459-1462; Quaba, O., Quaba, A., Pedicled perforator flaps for the lower limb (2006) Semin Plast Surg, 20, pp. 103-111; Erdmann, M.W., Court-Brown, C.M., Quaba, A.A., A five-year review of islanded distally based fasciocutaneous flaps on the lower limb (1997) Br J Plast Surg, 50, pp. 421-427; Babu, V., Chittaranjan, S., Abraham, G., Single-stage reconstruction of soft-tissue defects including the Achilles tendon using the dorsalis pedis arterialized flap along with the extensor digitorum brevis as bridge graft (1994) Plast Reconstr Surg, 93, pp. 1090-1094; Yang, Y.L., Lin, T.M., Lee, S.S., The distally pedicled peroneus brevis muscle flap anatomic studies and clinical applications (2005) J Foot Ankle Surg, 44, pp. 259-264; Koshima, I., Ozaki, T., Gonda, K., Posterior tibial adiposal flap for repair of wide, full-thickness defect of the Achilles tendon (2005) J Reconstr Microsurg, 21, pp. 551-554; Jakubietz, R.G., Kloss, D.F., Gruenert, J.G., The 180 degree perforator based propeller flap for soft tissue coverage of the distal lower extremity: A new method to achieve reliable coverage of the distal lower extremity with local perforator flap (2007) Ann Plast Surg, 59, pp. 667-671

PY - 2015

Y1 - 2015

N2 - Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. The purpose of this article was to present our experience of 11 patients who underwent reconstruction of soft tissue defects of the Achilles tendon using bipedicled fasciocutaneous flaps. Between August 2008 and August 2012, 11 patients were admitted to our hospital, presenting with soft tissue defects overlying the Achilles tendon. After adequate debridement, the 11 patients underwent bipedicled fasciocutaneous flap placement to resurface the complex soft tissue defects and provide a gliding surface for the exposed Achilles tendon. The patients' age, comorbidity, etiology, defect size and location, wound culture, skin graft size, complications, surgery duration, and follow-up period were reviewed. The 11 fasciocutaneous bipedicled flaps survived completely, and the wounds healed satisfactorily at a mean follow-up period of 20.9 months (range, 6-48 months). Only 1 flap was complicated with wound dehiscence and superficial necrosis of its lateral edge, which healed conservatively. The donor sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or elderly patients. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. Thus, the bipedicled fasciocutaneous flap can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.

AB - Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. The purpose of this article was to present our experience of 11 patients who underwent reconstruction of soft tissue defects of the Achilles tendon using bipedicled fasciocutaneous flaps. Between August 2008 and August 2012, 11 patients were admitted to our hospital, presenting with soft tissue defects overlying the Achilles tendon. After adequate debridement, the 11 patients underwent bipedicled fasciocutaneous flap placement to resurface the complex soft tissue defects and provide a gliding surface for the exposed Achilles tendon. The patients' age, comorbidity, etiology, defect size and location, wound culture, skin graft size, complications, surgery duration, and follow-up period were reviewed. The 11 fasciocutaneous bipedicled flaps survived completely, and the wounds healed satisfactorily at a mean follow-up period of 20.9 months (range, 6-48 months). Only 1 flap was complicated with wound dehiscence and superficial necrosis of its lateral edge, which healed conservatively. The donor sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or elderly patients. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. Thus, the bipedicled fasciocutaneous flap can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.

KW - Achilles tendon

KW - bipedicled flap

KW - soft tissue defect

KW - achilles tendon

KW - adult

KW - aged

KW - case report

KW - evaluation study

KW - female

KW - follow up

KW - human

KW - injuries

KW - male

KW - middle aged

KW - plastic surgery

KW - procedures

KW - surgical flaps

KW - Tendon Injuries

KW - treatment outcome

KW - vascularization

KW - Achilles Tendon

KW - Adult

KW - Aged

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Reconstructive Surgical Procedures

KW - Surgical Flaps

KW - Treatment Outcome

U2 - 10.1097/SAP.0b013e3182a1e508

DO - 10.1097/SAP.0b013e3182a1e508

M3 - Article

VL - 74

SP - 484

EP - 487

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 4

ER -