Reconstruction of skin defects around the Achilles tendon with rectangle advancement flap in children

Abstract

Objective To explore the clinical efficacy of rectangle advancement flaps used in the re-construction of skin defects around the Achilles tendon in children. Methods From May 2014 to June 2015, 7 children with skin defects around the Achilles tendon were admitted to our trauma center. The areas of skin defect ranged from 3.4 cm × 2.7 cm to 5.5 cm × 4.0 cm. The integrity of Achilles tendon was preserved in 6 cases but the tendon insertion was partly disrupted in one case. The skin defects were reconstructed with self-designed rectangle advancement flaps after debridement. In the one case with the Achilles tendon partly disrupted, the contaminated tendon ends were excised before wound closure. The injured ankles were immobilized in plantar flexion with one 1.5 mm K-wire and plaster splint to decrease the postoperative tension of the flap. Results All the flaps survived completely by primary intention but local infection occurred in 2 wounds which was cured by second intention of dressing change. The follow-up periods ranged from 8 to 12 months (average, 11.5 months). The scar around the flap was remarkable in 2 cases, but the flaps in the other cases ap-peared normal in terms of color and texture. The ankle function was satisfactorily normal in all the cases. Conclusion Our self-designed rectangle advancement flaps provide a simple, safe and reliable way to repair skin defects around the Achilles tendon in children. Key words: Foot; Wounds and injuries; Surgical flaps; Child