Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Combined Free Tissue Transfer For The Management Of Composite Achilles Defects: Functional Outcomes And Patient Satisfaction Following Vascularized Reconstruction With A Neo-tendon Construct
Michael DeFazio, M.D., Chrisovalantis Lakhiani, M.D., Kevin D. Han, M.D., Christopher Attinger, M.D., Karen K. Evans, M.D.
Georgetown University Hospital, Washington, DC, USA.

PURPOSE:
Free tissue transfer with a vascularized tendon construct permits single-stage reconstruction of composite Achilles/posterior leg defects. While this approach appears to offer a solution to high rates of recurrent infection and tendon failure, long-term functional outcomes and quality-of-life measures following salvage reconstruction are limited. We present our experience and outcomes following combined Achilles defect reconstruction utilizing vascularized neo-tendon constructs.
METHODS:
A series of six patients underwent vascularized reconstruction of Achilles tendon and soft tissue defects, by a single surgeon (K.K.E.), between October 2011 and June 2012. Mechanism of injury, range of motion, calf circumference, and tiptoe ambulation were assessed for each patient. Subjective evaluation and quality-of-life measures were obtained pre- and postoperatively using the AOFAS Ankle-Hindfoot and SF-36 scores. Early and late complications were noted for each case.
RESULTS:
Achilles defects were reconstructed using an anterolateral thigh/vascularized fascia lata flap in five cases (Figure 1). For one patient with inadequate anterolateral skin perforators, a free rectus femoris/posterior rectus fascial flap was used. The average soft tissue defect was 76.7 cm2 (r, 40 - 90 cm2) with a tendon gap of 7.8 cm (r, 5 - 10 cm). Mean follow-up was 17 months (r, 15 - 23 months). Flap survival was 100%, and all patients returned to pre-injury level of activity by 1 year postoperatively (Table 1). Overall range of motion of the reconstructed side was 82% of the unaffected side (48.2° vs. 59°, p = 0.004). Average percent increase in AOFAS and SF-36 scores were 71% (54 vs. 93, p = 0.0005) and 22% (86 vs. 104, p = 0.003), respectively (Table 2). Operative revision was required for 2 patients with delayed-onset soft tissue infections and 1 donor site hematoma. Distal flap ischemia was managed with hyperbaric oxygen therapy in 1 patient. Functional and aesthetic outcomes were judged good to excellent by all patients (Figure 2).
CONCLUSION:
Free tissue transfer with vascularized tendon reconstruction is a viable option for patients with combined Achilles tendon/posterior leg defects, as both functional and quality-of-life measures were significantly improved at one year postoperative follow-up.




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