Long-Term Outcomes of Gastrocnemius V-Y Plasty Gastrosoleus Fascial Turndown Flap for Chronic Tendo-achilles Injuries with Complex Gap (Kuwada Type IV Injuries).

Abstract

The Achilles tendon is one of the strongest and most ruptured tendons; with no appropriate treatment it either heals in elongation or gap nonunion. Management of such chronic tears is critical and several procedures have been described. Complex gaps of over 6-8cm need a combination technique. To assess the long-term functional outcome of surgical technique of combined gastrosoleus turndown flap augmented with V-Y plasty for chronic tendoachilles tear with a complex gap of over 8cm. We retrospectively analyzed all the patients who were operated for tendoachilles tears from 2013 to 2018 and selected 12 patients who had a gap of 8cm. Demographic details, history, clinical and radiological findings, post-op follow-up were collected from hospital database. The acute, open, chronic tears with gap of < 8cm, peripheral vascular diseases were excluded. All the procedures were done by senior surgeon using combined technique of gastrosoleus turndown flap with V-Y plasty. Functional outcome was assessed using modified Rupp score, calf diameter and VAS scoring system at latest follow-up of the patient. Assessing increase in calf diameter did objective analysis, average of 2.2cm was regained which was statistically significant using paired T test. Each patient regained average 10° of dorsiflexion. Two patients had terminal 10° restriction of plantar flexion. All patients were able to do heel raise and single leg stance for at least 30s. Subjective assessments done using modified Rupp score, five patients had excellent and seven patients had good outcome. Mean VAS for pain was 1.5 (1-3) and VAS for satisfaction was 7.5 (6-9). All patients returned to their pre-injury functional status. Combined surgical technique of gastrosoleus turndown flap augmentation with V-Y plasty for repairing complex defects in chronic achilles tendon tears is a fair option with satisfactory functional outcome and fewer complications. The online version contains supplementary material available at 10.1007/s43465-021-00475-6.