Traumatic rupture of the Achilles tendon with large tendon and skin defect

Abstract

INTRODUCTION: The reverse sural fasciocutaneous flap (RSFF) described by Masquelet et al. is helpful for the reconstruction of injuries around the heel and ankle. Skin defects around the heel are common but rarely associated with total Achilles tendon rupture. Various types of grafts have been published for Achilles tendon reconstruction; Myerson describes the use of an Achilles tendon allograft with a calcaneal bone block for the treatment of degenerative Achilles tendinopathy, but there are no reports of its use in acute cases.

OBJECTIVE: To demonstrate the feasibility of combining the reverse sural flap with cadaveric Achilles tendon allograft in acute injuries and to describe its final functional outcome.

CASE PRESENTATION: This is a clinical case report and literature review. A young adult patient with loss of skin coverage and complete rupture of the Achilles tendon at its calcaneal insertion. A cadaveric Achilles tendon graft was used for its surgical resolution and skin coverage with the reverse flow sural flap technique described by Masquelet. For functional assessment, the AOFASS scale was used.

DISCUSSION: The reverse flow sural flap is versatile and ideal for ankle reconstruction. Few studies have combined the reverse sural flap and Achilles tendon plasty at the same surgical time, but they have shown satisfactory results. The association of this technique with tendinoplasty using cadaveric allograft is unusual but very useful; in the present case proved to be effective, reducing surgical times and reproducing excellent functional results without any complications.