Exposed Achilles Tendon Research Articles

Bioabsorbable Temporizing Matrix (BTM): Not Just for Burns.

A skin substitute developed in Australia 2 decades ago for use in acute burns was recently introduced into the United States for the treatment of open wounds. This product has been shown to be very efficacious for coverage of debrided burn wounds. It consists of an inorganic synthetic woven layer that induces cellular ingrowth and deposition of interstitial tissue. It is covered by an attached silicone layer that seals the wound. The product is placed with the woven side directly on the wound. It is fixed in place and optimally covered by a negative pressure dressing for the first 5-10 days. Due to its synthetic composition, it is highly resistant to infection and can stay on the wound for as long as needed. The authors have used this matrix in a wide variety of complex reconstructions in 27 patients, consisting of 10 females and 17 males. Eleven had traumatic wounds of various etiologies (deep burns, crush injuries, Morell-Lavallee lesion, hand injuries, multiple trauma, open fractures, compartment syndromes and soft tissue avulsions). The following wounds were also treated with BTM: pressure ulcers, axillary hidradenitis, scalp wounds, severe facial acne keloidalis, Fournier's gangrene, a diabetic foot ulcer, a chronic venous ulcer, a cutaneous pyoderma gangrenosum, a radiation ulcer with exposed Achilles tendon, a disfiguring scar from an old Dupytrens excision and a non-healing chemotherapy extravasation ulcer. Hand and leg wounds with exposed tendon achieved coverage without tethering. The scalp wounds developed a neodermis and were skin-grafted. A pyoderma gangrenosum patient with excessive slough and uncontrolled bleeding was temporarily immunosuppressed, aggressively debrided and covered with the matrix. Her bleeding resolved. She developed a neodermis, and had reduced symptoms. The Fournier's patient had immediate skin-grafting of his penis and testicles, but the remaining extensive perineal and upper thigh wounds were treated with the matrix and healed without additional skin grafting. A hand patient with a forearm fasciotomy wound was covered with the matrix. As the swelling resolved the size of the defect decreased to the point that the wound was delaminated. The adjacent skin was elevated and used to cover the open area, achieving full closure. There were no complications attributed to the use of the matrix. Several patients healed secondarily with the silicone sheeting gradually peeling off. Seven patients have received or are awaiting skin grafts to be placed over the neodermis. Although this is an early review of the use of this synthetic matrix in the US, it comes with a positive legacy from Australia. The findings thus far indicate that there is a wide range of applications for this product well beyond burn care. Its safety record, resistance to infection and ease of use facilitate surgery.

Critical Evaluation of Lateral Calcaneal Artery Fascio-Cutaneous Flap in Re-Surfacing Posterior Heel Defects: A Review of 24 Cases.

To assess feasibility and functional acceptability of lateral calcaneal artery fascio-cutaneous flap (LCAFCF) in providing cover to posterior heel defects in single stage. To provide stable and sensate cover to small and moderate posterior heel defects. This review was conducted in department of Burns & Plastic Surgery of Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana between October 2021 and September 2022 to analyse the clinical outcome of LCAFCF in 24 patients (18 males, 6 females) aged between 20 and 35years who had chronic dry wounds n = 9, failed primary reconstruction by reverse sural flap n = 1, granulated wounds n = 8, exposed achilles tendons n = 4 and scarred tissue restricting ankle joint movements n = 2 in region of posterior heel following trauma, while riding motor-cycle. Course of lateral calcaneal artery was marked with hand-held doppler. Flap size ranged from 3 to 3.5cm in width and 5.5-7.5cm length. The donor sites were split skin grafted. Sutures were removed on 22nd day of surgery. Mean follow up was 13months. All flaps survived. Two had partial loss of skin graft and two developed hyperkeratosis on grafted site. Sensations in flap, regain of movements of ankle joint, comfort of walking and driving were acceptable. LCAFCF is handy, safe and reliable flap for re-surfacing difficult wounds of posterior heel, therefore should be included in surgical armamentarium.

Reconstruction of overlying the achilles tendon with island V-Y advancement flap

Abstract Introduction: Soft tissue defects with exposed Achilles tendon is common in trauma. Surgically covering these defects by fasciocutaneous flap can preserve normal function of the Achilles tendon. Various methods have been described and reported in the literatures: local advancement flap, region flap, or free flap. The purpose of this article is to report the results of 10 cases who were operated to cover the Achilles tendon by perforator V-Y advancement flap, discuss the indications and advantages of using this flap. Patients and methods: A retrospective study describes 10 cases: 8 males and 2 females, aged from 4 to 71. The patients had soft tissue defect with expose Achilles tendon who were operated cover by V-Y advancement flap based on perforator of peroneal artery from 07/2018 to 05/2021. Follow-up time from 3 months to 3 years. Results: The size of defect is from 3x2 cm to 8x6 cm. The size of flap is from 3,5x4cm to 16x6 cm. All 10/10 flaps were total survival and completely cover the defect. All patients preserved normal function of the Achilles tendon. Conclusions: Using the V-Y advancement flap based on perforator of peroneal artery to cover the soft tissue defect with expose Achilles tendon had good results, restore normal function with good aesthetic. Keywords: V-Y advancement flap, Island perforator flap, Achille tendon coverage, Exposed Achille tendon.

V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type Ⅲ chronic Achilles tendon rupture

To investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect. Between February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation. The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05). V-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.

Two Refractory Cases of Ulcer with Achilles Tendon Exposure Treated with bFGF Inserted into Pelnac-Gplus&lt;sup&gt;®&lt;/sup&gt; Following Negative Pressure Wound Therapy

Two Refractory Cases of Ulcer with Achilles Tendon Exposure Treated with bFGF Inserted into Pelnac-Gplus&lt;sup&gt;®&lt;/sup&gt; Following Negative Pressure Wound Therapy

Repair of Small-Size Wound With Achilles Tendon Exposure With Proximal Pedicled Cutaneous Neurovascular Flap.

To investigate the clinical outcomes associated with repairing of small-sized wounds of Achilles tendon exposure with proximal pedicled cutaneous neurovascular flap in the dorsolateral foot. After thorough debridement, 16 cases with small-sized wounds of Achilles tendon exposure were repaired by proximal pedicled cutaneous neurovascular flap of the dorsolateral foot, and their clinical outcomes were observed. All the flaps in the 16 cases survived completely, excluding the marginal part necrosis in 1 case, and all the wounds were healed. The 2-point discrimination of the flaps was 14.53 ± 1.55 mm (range, 12-17 mm) in patients without sural nerve injury after 3 to 18 months follow-up. No discomfort was felt in wearing normal shoes by all the 16 patients. It is reasonable to repair the small-sized wounds of Achilles tendon exposure with proximal pedicled cutaneous neurovascular flap of dorsolateral foot due to its effective repair of the wound, relatively uncomplicated surgery, and had satisfactory healing recovery.

Heel Reconstruction With Bipedicled Flap: A Salvage Procedure.

Reconstruction of the heel region poses great challenge to plastic surgeons not only due to calcaneal bone lying just deep to the subdermal fat pad but also due to easily exposed Achilles tendon. In order to achieve permanent closure of the heel defect, exposed bone or tendon-or both-should be covered with durable, preferably sensate, well-vascularized, thin skin flaps. Even though fasciocutaneous free flaps remain the gold standard in the reconstruction of heel defects with exposed bone or tendon, a significant number of these patients are older individuals with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 6 patients (1 female, 5 males), we present a new technique of reconstruction with a bipedicled flap as a safe, reliable, and efficient reconstructive modality in the treatment of heel defects in cases where free flaps and other more sophisticated reconstructive options are either not feasible or have failed. Achieving complete reconstruction of defects in all 6 patients, this technique proves to be successful as a salvage procedure in reconstruction of heel defects.

A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture

ObjectiveAcute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture. MethodsFifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography. ResultsMean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients. ConclusionsThe novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.

Use of lateral calcaneal flap for coverage of posterior heel defects

Lateral calcaneal flap is frequently used for coverage of lateral calcaneum and posterior heel defects. We conducted a prospective study using lateral calcaneal artery flap to cover posterior heel defects from July 2011 to June 2015 in the Department of Burn and Plastic Surgery, Khulna Medical College to observe the clinical outcome of use of lateral calcaneal artery flap. A total number of ten soft tissue defects in posterior heel with and without exposed Achilles tendon or calcaneus due to different causes were reconstructed with lateral calcaneal artery flap. All ten flaps survived completely with no subsequent breakdown of the skin, even after regular wearing of normal shoes. The flap donor sites were grafted with split-thickness skin grafts in all cases. Partial graft loss was noted in two cases which were eventually healed spontaneously with dressing without the need for a secondary graft. Epidermal necrosis developed in one case which was ultimately healed with conservative treatment. There was no loss of sensation in flap area but sensory disturbance at the lateral part of the dorsum of foot was found in all cases. Our results were satisfactory in terms of coverage adequacy, perioperative morbidity, and functional and aesthetical outcomes. The lateral calcaneal artery skin flap can be used safely to provide sensory skin coverage in posterior heel defects.Mediscope Vol. 4, No. 1: Jan 2017, Page 5-10

Longitudinal slit procedure combined with negative-pressure wound therapy for exposed Achilles tendons.

Longitudinal slit procedure combined with negative-pressure wound therapy for exposed Achilles tendons.

Wrap technique to cover exposed Achilles tendon with the soleus muscle

Numerous etiologies may lead to loss of Achilles tendon coverage. Currently, multiple coverage options are available to the reconstructive surgeon; however, described techniques may not meet every patient’s need. In this case report, we describe the use of a simple technique, utilizing the soleus to cover exposed Achilles by folding the muscle circumferentially around the tendon. The technique described is a local option, creates minimum morbidity, does not require microsurgical skills, and can be performed quickly. Level of Evidence: Level V, therapeutic study.

Bipedicled flap reconstruction of soft tissue defect with Achilles tendon exposure

Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. Here, we present our recent experience of using a bipedicled fasciocutaneous flap to resurface the complex soft tissue defect and provide a gliding surface for the exposed Achilles tendon. The donor-sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap survived completely, and the wound healed satisfactorily at 2 months follow-up. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or advanced age. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. This method can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically.

Select Practices in Management and Rehabilitation of Burns: A Survey Report

The purpose of this study is to document the organization and current practices in physical rehabilitation across burn centers. An online survey developed for the specific purposes of this study sought information regarding a) logistics of the burn center; b) inpatient and outpatient treatment of patients with burn injury; and c) specific protocols in the treatment of a few complications secondary to burn injuries. Of the 159 responses received, 115 were received from the United States, 20 from Australia, 16 from Canada, and 7 from New Zealand. The overall sample included responses from 76 physical therapists (PTs) and 78 occupational therapists. Seventy-three of those surveyed considered themselves primarily a burn therapist. Nurses (86%) were reported as primarily responsible for wound care of inpatients, followed by wound care technicians (24%). Ninety-seven percent of the therapists reported following their own treatment plans. The trunk and areas of head and neck were treated by both PTs and occupational therapists, whereas the lower extremities continue to be treated predominantly by PTs. Some common practices regarding treatment of a few complications secondary to burn injuries such as splinting to prevent contractures, treatment of exposed or ruptured extensor tendons, exposed Achilles tendons, heterotopic ossification, postoperative ambulation, conditioning, scar massage, and use of compression garments are described. Opportunities exist for 1) developing a common document for practice guidelines in physical rehabilitation of burns; and 2) conducting collaborative studies to evaluate treatment interventions and outcomes.

Bicycle-Spoke Injuries of the Foot in Children

To evaluate the characteristics of bicyclespoke injuries in a suburban Indian population. 30 male and 11 female children aged 4 to 12 (mean, 6) years with bicycle-spoke injuries were prospectively studied. Data collected included patient age, gender, position at the time of injury, site, type, and characteristics of the injury. According to the Oestern and Tscherne classification, soft-tissue injuries were classified into grades 0 to 3. 37 patients injured the right foot, and 4 the left foot; 34 by the rear wheel and 7 by the front wheel. All front-wheel injuries involved the forefoot and midfoot. 73% of injuries involved the lateral aspect of the ankle. The most common injury site was the posterior ankle (n = 30), followed by the medial midfoot (n = 7), and the forefoot (n = 3). Partial avulsion of heel flap and an exposed Achilles tendon were each noted in 2 patients. 10, 13, 14, and 4 patients sustained soft-tissue injuries of grades 0, 1, 2, and 3, respectively. Eight patients had associated fractures. All fractures healed uneventfully. Marginal necrosis of the wound was noted in 5 patients, but none required a skin graft. No patient had functional impairment or residual tenderness of the foot. Bicycle-spoke injuries usually affected the ankle region, and the wound was usually deeper than it appeared on initial examination. Reassessment of the wound after 48 hours is recommended. Severity of soft-tissue injury was the determinant of overall function; bone fractures by themselves did not alter the duration of recovery. To prevent bicyclespoke injuries, spoke guards and foot rests should be used, and children being carried on a bicycle should wear proper shoes. Education on injury mechanism, severity, and preventive measures is also important.

The ankle extensor-tendon-sheath flap – a versatile fascial flap for coverage of the tibia and pretibial area: A preliminary report

In April 2003, the author presented the use of the common peroneal tendon sheath as a vascularised fascial flap serving to cover exposed Achilles tendons in four patients. This flap was referred to as the peroneal tendofascial flap. The gross anatomy and blood supply of the tendon sheaths in the extensor compartment of the leg were studied in 15 below-knee amputation specimens. The tendon sheath was found to possess two distinct layers: an inner one that harbours the synovial sheath and belongs to each tendon separately, and a common outer layer ensheathing all the tendons within the extensor compartment. The outer layer was mainly nourished via five septal perforators anastomosing with each other. These anastomoses result in forming longitudinal sizeable vessels along the septum. The dissection of this newly described layer resulted in a proximally based axial fascial flap in four cases. The flaps with overlying split-thickness skin grafts (STSGs) were used successfully to cover soft-tissue defects overlying the tibia and pretibial area. Follow-up for at least 6 months proved the durability and sufficient coverage of the ankle extensor-tendon-sheath flap.

Muscle embedment spacer for large segmental exposed Achilles tendon: a preliminary report

Objective to access the therapeutic methods and results of muscle embedment spac-er for large segemental exposed achilles tendon. Methods There were 21 patients diagnosed as Achil-les tendon rupture combined with local cutaneous deficiency, of whom 16 patients were combined with comminuted tibial fractures and artery and nerve injury, 13 combined with shock, six combined with pel-vic fractures, two combined with open homolateral femoral fractures and three combined with hepatorrhexis and splenic rupture. All patients received fracture fixation and treatment for vascular and nural injuries, hepatorrhexis and splenic rupture. The ruptured Achilles tendons were embedded in the triceps surae muscle at one stage. The Achilles tendons and cutaneous deficiency were repaired at second stage. Re-suits The embedded Achilles tendons assumed a relatively fresh and tramosericeous adventitious coat and retained good tenacity, with no signs of necrosis, colliquation or infection. The follow-up time after second operation was 15-27 months (average 18 months), which showed excellent results in 15 patients, good in four and poor in two, with excellence rate of 90%. All skin flaps and residual wounds were pri-marily healed and no repaired Achilles tendons disrupted again. Conclusion The muscle embedment spacer method can largely avoid the ischemic necrosis of Achilles tendon due to long time exposure and hence provide adequate conditions for second stage operation. Key words: Wounds and injuries; Muscles; Tissue embedding; Achilles tendon

Vakuumtherapie bei tiefem Wundinfekt nach Achillessehnenrekonstruktion

Vacuum therapy is a valuable option for wound healing complications. After reconstruction of the ruptured achilles tendon, deep wound infections are difficult to handle due to impaired circulation of the bradytrophic tissue which leads to infection and a protracted healing process. Consecutive necrosis of the achilles tendon results in a poor clinical outcome. We could prove that vacuum therapy is the method of choice for wound healing complications in this delicate area. We treated 5 patients with deep wound infection and exposed achilles tendon after reconstruction. In all cases we achieved complete closure. The function of the achilles tendon was not impaired. Sonography confirmed the integrity of the tendon in all cases. Duration of therapy was 8.4 days for inpatient treatment and 64.4 days overall. 3 patients received a mesh-graft transplantation after wound ground preconditioning with vacuum therapy, all others achieved complete restoration with vacuum only. Vacuum therapy is a valuable option for the treatment of infected achilles tendon after surgical repair. After wound ground conditioning, it can protect mesh-graft transplants in this delicate area even in non-compliant patients.

The Effect of Butyric Acid Coated Sutures on Cell Proliferation and Angiogenesis in Aged Rabbit Achilles Tendon: A Potential Stimulus for Rotator Cuff Repair (SS-11)

Many methods have been studied to improve the rate of cuff healing. Tendons sutured with Butyric Acid coated sutures demonstrated significantly increased angiogenic activity at 7 days post-op. This was seen both with increased mRNA expression of VEGF and with the increased DNA concentration. This trend continued throughout the 45 days of the study. These biochemical findings were further supported by the histological findings of increased cellularity and vascularity of the BA treated tendons. To compare the angiogenic effects of Butyric acid coated suture versus a control suture on an aged tendon model. 24 aged rabbits underwent bilateral Achilles tendon exposure. Butyric acid coated ultrabraid suture was sutured into one side while a control ultrabraid suture was sutured into the contralateral side in a similar fashion. The rabbits were sacrificed at 7, 30, and 45 days and the tendons were harvested for gross, histological, and biochemical evaluation. DNA concentration was significantly higher in the BA treated tendon group relative to control at 7 days (p=0.06) but unchanged at 30 and 45 days. Similarly, the mRNA expression of VEGF was significantly greater in the BA treated tendon at 7 days (p=0.05). A strong trend for higher expression in the BA group was also observed at 30 days (p=0.12). Histologically there was increased vascularity and cell migration at all time points in the BA treated tendons. The proteoglycan concentration was increased in the BA treated tendons at 30 and 45 days. There were no differences observed between the two groups on gross morphological examination. BA treated tendons demonstrated significantly increased angiogenic activity at 7 days post-op. This was seen both with increased mRNA expression of VEGF and with the increased DNA concentration. This trend continued for up to 30 days and leveled off by 45 days. These biochemical findings were further supported by the histological findings of increased cellularity and vascularity of the BA treated tendons. The proangiogenic properties of a BA coated suture on tendon could be an effective tool to augment rotator cuff repair as well as in repair of other compromised tissue.

Peroneal artery perforator‐based propeller flap reconstruction of the lateral distal lower extremity after tumor extirpation: Case report and literature review

Soft tissue defects in the distal lower extremity present a formidable challenge due to the lack of reliable local flap options. Pedicled adipofasciocutaneous flaps provide the closest match to local tissues, but random pattern flaps are limited in reliability, size, reach, and arc-of-rotation. One hundred and eighty degree perforator-based propeller flaps are an innovative option because they provide robust axial perfusion to flaps with significantly greater surface area and ease of transposition versus that provided by their random pattern counterparts in these anatomic regions traditionally addressed with free tissue transfer. We present a rare case of aggressive digital papillary carcinoma of the posteriolateral ankle and Achilles region. Wide local excision resulted in a defect with Achilles tendon exposure and denudation. A fasciocutaneous propeller flap based on a dominant peroneal artery perforator was raised and rotated 180 degrees to resurface the wound, providing a gliding surface for Achilles tendon function. The reconstruction was successful with no complications, excellent contour, and esthetic appearance. Peroneal perforator-based propeller flaps in the ankle region are useful local options providing unparalleled form and function, with excellent surface area and mobility, for dynamic areas of the lower extremity, without sacrificing any major vessels or nerves. This technique adds to the reconstructive microsurgeon's armamentarium for complex coverage of the ankle region.

Single-stage reconstruction of Achilles tendon injuries and distal lower extremity soft tissue defects with the reverse sural fasciocutaneous flap

Complex wounds of the lower extremity with concomitant Achilles tendon injury can be difficult to reconstruct. We favour the reverse sural artery fasciocutaneous flap because in a single step, flap elevation affords Achilles tendon exposure and adequate soft tissue for reconstruction. It also provides significant time and resource savings for both plastic and orthopaedic surgical teams. Our case series involved four consecutive patients who presented with Achilles tendon injuries and concomitant complex soft tissue defects. The reverse sural artery flap was planned in conjunction with the orthopaedic service to facilitate their approach for Achilles tendon repair. Outcome was measured as flap survival, time for flap elevation and total operative time. Partial flap loss occurred in one patient. The Achilles repair was performed successfully in all cases. The mean time for flap elevation and Achilles exposure was 43 min (range, 37-52 min). Total operative time was 287 min (range, 211-347 min). The reverse sural artery fasciocutaneous flap is a durable, efficient option for simultaneous Achilles tendon reconstruction and wound coverage. Simple flap elevation provides necessary exposure of the Achilles tendon for repair while the flap itself provides ample soft tissue with a reliable blood supply. In our experience, the reverse sural artery fasciocutaneous flap affords a practical method to address two reconstructive challenges in a single procedure.