Picture #1: Achilles Tendon Infection & Wound, 1 month after Rupture and Repair
Picture #2: Gracillis Muscle Free Flap as Vascularized Musculotendinous Reconstruction of Achilles Tendon Loss after Infection
Picture #3: Full Range of Motion of Ankle with Functional and Intact Achilles Tendon
Picture #4: Full Range of Motion of Ankle with Functional and Intact Achilles Tendon
The Achilles tendon is the largest tendon in the human body and a critical component in the function of the ankle joint to allow “push off” movement in walking and running. It is commonly ruptured during sports activities that require treatment by the orthopedic surgeon to repair the tendon. Usually the patient goes on to do well from this.
In some rare circumstances, the repaired tendon can become infected which can threaten the viability of the tendon. By the time we see the patient, the wound is quite large and severely infected. The patient is concerned about playing sports again.
Depending on the severity of the infection, multiple options are available to save this situation. Most importantly the wound needs to be explored and cleaned. Afterward the anatomy of the wound is further delineated. If the tendon loss is small, the wound up may be closed with local tissues and future tendon graft. If the tendon loss is moderate to large, a more complex reconstruction can be performed with both tendon and skin. This usually requires microsurgical expertise where tissue is transplanted to reconstruct the lost tissue.
We have used both the Gracillis muscle+tendon and the ALT (Antero Lateral Thigh) flap to reconstruct this complex defect with a high degree of success using microsurgical techniques. This requires an orthopedic and plastic surgery approach to combine their expertise to maximize functional recovery of the leg. Patients with Achilles’ tendon ruptures are usually young and healthy men. Everything should be done, and all the options discussed to bring the injured leg back to as near normal function as possible.