Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Functional Reconstruction of a Combined Tendocutaneous Defect of the Achilles Using a Segmental Rectus Femoris Myofascial Construct: A Viable Alternative

  • DeFazio, Michael Vincent (Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital) ;
  • Han, Kevin Dong (Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital) ;
  • Evans, Karen Kim (Department of Plastic Surgery, Center for Wound Healing, Medstar Georgetown University Hospital)
  • Received : 2013.12.22
  • Accepted : 2014.02.18
  • Published : 2014.05.15
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Abstract

The composite anterolateral thigh flap with vascularized fascia lata has emerged as a workhorse at our institution for complex Achilles defects requiring both tendon and soft tissue reconstruction. Safe elevation of this flap, however, is occasionally challenged by absent or inadequate perforators supplying the anterolateral thigh. When discovered intraoperatively, alternative options derived from the same vascular network can be pursued. We present the case of a 74-year-old male who underwent composite Achilles defect reconstruction using a segmental rectus femoris myofascial free flap. Following graduated rehabilitation, postoperatively, the patient resumed full activity and was able to ambulate on his tip-toes. At 1-year follow-up, active total range of motion of the reconstructed ankle exceeded 85% of the unaffected side, and donor site morbidity was negligible. American Orthopaedic Foot and Ankle Society and Short Form-36 scores improved by 78.8% and 28.8%, respectively, compared to preoperative baseline assessments. Based on our findings, we advocate for use of the combined rectus femoris myofascial free flap as a rescue option for reconstructing composite Achilles tendon/posterior leg defects in the setting of inadequate anterolateral thigh perforators. To our knowledge, this is the first report to describe use of this flap for such an indication.

Keywords

References

  1. Lee JW, Yu JC, Shieh SJ, et al. Reconstruction of the Achilles tendon and overlying soft tissue using antero-lateral thigh free flap. Br J Plast Surg 2000;53:574-7. https://doi.org/10.1054/bjps.2000.3407
  2. Kuo YR, Kuo MH, Chou WC, et al. One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment. Ann Plast Surg 2003;50:149-55. https://doi.org/10.1097/01.SAP.0000037270.95257.B9
  3. Kimata Y, Uchiyama K, Ebihara S, et al. Anatomic variations and technical problems of the anterolateral thigh flap: a report of 74 cases. Plast Reconstr Surg 1998;102:1517-23. https://doi.org/10.1097/00006534-199810000-00026
  4. Celik N, Wei FC, Lin CH, et al. Technique and strategy in anterolateral thigh perforator flap surgery, based on an analysis of 15 complete and partial failures in 439 cases. Plast Reconstr Surg 2002;109:2211-6. https://doi.org/10.1097/00006534-200206000-00005
  5. Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004;26:759-69. https://doi.org/10.1002/hed.20050
  6. Liang CC, Jeng SF, Yang JC, et al. Use of anteromedial thigh flaps as an alternative to anterolateral thigh flaps for reconstruction of head and neck defects in cancer patients. Ann Plast Surg 2013;71:375-9. https://doi.org/10.1097/SAP.0b013e31824f20bb
  7. Lin CH, Wei FC, Lin YT, et al. Lateral circumflex femoral artery system: warehouse for functional composite free-tissue reconstruction of the lower leg. J Trauma 2006;60:1032-6. https://doi.org/10.1097/01.ta.0000218248.22811.70
  8. Koshima I, Moriguchi T, Soeda S, et al. Free rectus femoris muscle transfer for one-stage reconstruction of established facial paralysis. Plast Reconstr Surg 1994;94:421-30.
  9. Wei CY, Chuang DC, Chen HC, et al. The versatility of free rectus femoris muscle flap: an alternative flap. Microsurgery 1995;16:698-703. https://doi.org/10.1002/micr.1920161008
  10. Lin CH, Lin YT, Yeh JT, et al. Free functioning muscle transfer for lower extremity posttraumatic composite structure and functional defect. Plast Reconstr Surg 2007;119:2118-26. https://doi.org/10.1097/01.prs.0000260595.85557.41
  11. Wong CH, Ong YS, Wei FC. Revisiting vascular supply of the rectus femoris and its relevance in the harvest of the anterolateral thigh flap. Ann Plast Surg 2013;71:586-90. https://doi.org/10.1097/SAP.0b013e318255a2ac
  12. Dibbell DG Jr, Mixter RC, Dibbell DG Sr. Abdominal wall reconstruction (the "mutton chop" flap). Plast Reconstr Surg 1991;87:60-5. https://doi.org/10.1097/00006534-199101000-00011
  13. Freedman AM, Gayle LB, Vaughan ED, et al. One-stage repair of the anterior abdominal wall using bilateral rectus femoris myocutaneous flaps. Ann Plast Surg 1990;25:299-302. https://doi.org/10.1097/00000637-199010000-00010
  14. Daigeler A, Dodic T, Awiszus F, et al. Donor-site morbidity of the pedicled rectus femoris muscle flap. Plast Reconstr Surg 2005;115:786-92. https://doi.org/10.1097/01.PRS.0000152422.64505.2A
  15. Gardetto A, Raschner C, Schoeller T, et al. Rectus femoris muscle flap donor-site morbidity. Br J Plast Surg 2005; 58:175-82. https://doi.org/10.1016/j.bjps.2004.08.001

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  1. Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon reconstruction: Surgical technique, functional results, and gait analysis vol.35, pp.8, 2014, https://doi.org/10.1002/micr.22481
  2. Early mobilizing and dangling of the lower leg after one-stage reconstruction of Achilles tendon and overlying tissue defect using an anterolateral thigh flap with vascularized fascia lata vol.4, pp.1, 2014, https://doi.org/10.1080/23320885.2017.1396902
  3. Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue vol.28, pp.3, 2014, https://doi.org/10.1177/2309499020971863