Different Modalities of Flap Coverage of Achilles Tendon Region Defects: Functional and Aesthetic Outcomes

Abstract Background: In the decision-making process toward covering various Achilles' tendon region, knowledge about patient related outcomes after surgery and rehabilitation is important. Therefore, we aimed to present an overview of outcomes and select the most appropriate flaps used for covering soft tissue defects over Achilles' tendon region. Aim of Study: Study aimed to analyse and determine the suitable reconstructive surgical options for Achilles' tendon coverage and to evaluate the clinical, functional and aesthetic outcomes. Patients and Methods: Between September 2017 and December 2019, 25 patients with skin loss over Achilles' tendon region were admitted to Menoufia University Hospital and Shebin-Elkom Teaching Hospital. The soft tissue defects ranged from 3x2 to 16x12 cm. Six types of flaps were used for the coverage of concomitant skin defects. Results: There was no complete flap loss and all flaps survived. Lateral supra malleolar flap (28%) was used in seven patients, distally based peroneus brevis muscle flap (16%) in four patients, posterior tibial artery perforator flap (24%) in six patients, peroneal artery perforator flap (4%) in one patient, reversed sural artery flap (24%) in six patients, and free latissimus dorsi musculocutaneous flap (4%) in one patient. Two patients were subjected to debridement and covered with split thickness skin graft (STSG). One patient suffered from chronic ulcer formation which was covered with lateral supra malleolar artery flap. The algorithm of one-stage reconstruction was established, according to the defect size of skin. Conclusion: Perforator flaps, lateral supra malleolar artery flap, and the distally based peroneus brevis muscle flap were a suitable option for coverage of small to intermediate sized defects; reversed sural artery flap is best for coverage of moderate to large size defects and free flaps are the best choices for complex wide reconstructions.