Repair of soft tissue defect around posterior calcaneal region combined with Achilles tendon defect by the thin-layer free anterolateral thigh flap with iliotibial band

Abstract

Objective To investigate the clinical effect of thin-layer free anterolateral thigh flap with iliotibial tract for reconstruction of heel soft tissue and Achilles tendon defect. Methods From January, 2017 to December, 2017, 11 cases of heel soft tissue and Achilles tendon defect were repaired by thin-layer free anterolateral thigh flap with iliotibial tract. There were 5 cases with tibia/fibula fracture, 3 cases with ankle fracture and 1 case with calcaneal fracture. The area of soft tissue defect was 6.5 cm×10.0 cm-8.0 cm×13.0 cm, and the length of Achilles tendon defect was 5.5-11.5 cm. All wounds were treated with debridement and negative pressure sealing drainage technique at first stage. After 6 days, the soft tissue defect around posterior calcaneal region combined with Achilles tendon defect were repaired by the thin-layer free anterolateral thigh flap with iliotibial tract. Reasonable rehabilitation training was established after operation. Results The flaps survived in 11 cases and the donor region healed in one stage. The patients were followed-up for 8 to 20(mean, 15.74) months by outpatient review, calling or WeChat. Slightly bloated in appearance in 2 cases, and were thinned by orthopedic operation 1 year later. The other flaps were well shaped and moderately thick. At the last follow-up, the flaps were soft in texture and elastic. The sensory recovery of the flap was good, and the two-point discriminant perception in the posterior region of the heel was 3.0-5.0(mean, 4.11) mm. Thompson’s sign was negative, double or one-foot heel lift test was negative, and there was no recurrence of Achilles tendon rupture or skin ulceration in the heel region. The range of motion(ROM) of affected side was (23.11±1.17)°of extension and (43.67±1.06)° of flexion, and the ROM of normal side was (23.79±1.03)°of extension and (44.03±0.94)°of flexion. There was no statistical difference between them(P>0.05). Postoperative follow-up was conducted according to the Thermann’s function evaluation system, the evaluated result was excellent in 8 cases, good in 2 cases, and receivability in 1 case. Conclusion It is a reliable and effective method to repair heel soft tissue and Achilles tendon defect by thin-layer free anterolateral thigh flap with iliotibial tract. And this method can better restore foot ankle shape and function. Key words: Anterolateral thigh flap; Iliotibial band; Heel; Achilles tendon defect; Microsurgical operation