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KMID : 1038220190460030267
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Archives of Plastic Surgery
2019 Volume.46 No. 3 p.267 ~ p.271
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Achilles tendon reconstruction with a half-width Achilles graft and wrap-around fascial flap
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Prasetyono Theddeus Octavianus Hari
Sisca Fransisca
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Abstract
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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 non-tourniquet 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.
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KEYWORD
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Achilles tendon, Gait, Reconstructive surgical procedures, Tourniquets
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