Huded Vijaykumar, Khodnapur Gireesh, Senthurvelan Ajayguru, Sai Reddy Munugala Charan
Hand and Micro Vascular Surgery, Ganga Hospital, Coimbatore, IND.
Plastic Surgery, Shri B M Patil Medical College, Hospital, and Research Centre, BLDE (Deemed to Be University), Vijayapura, IND.
Cureus. 2025 May 7;17(5):e83631. doi: 10.7759/cureus.83631. eCollection 2025 May.
Plastic surgeons continue to face considerable challenges while reconstructing exposed Achilles tendon. Several alternatives for repairing such defects include the reverse sural artery flap, peroneus brevis flap, propeller flap, lateral calcaneal artery flap, and peroneal artery perforator flap. However, each of these techniques has its pros and cons. This study compares our clinical experience to various reconstructive techniques for exposed Achilles tendon.
Fifteen individuals had their exposed Achilles tendon reconstructed between October 2023 and July 2024. These fifteen cases were classified based on the origin of the wound, comorbidities, operational results, and complications, which were analyzed using a prospective study.
The average age of the patients was 40. All 15 patients tolerated the flap procedure well without significant complications; however, one patient with a reverse sural flap developed complete flap necrosis and required secondary split-thickness skin grafting. One more patient had distal tip necrosis and healed with secondary intention. One patient developed an infection, which was resolved by debridement and consecutive dressings. None of the patients had any functional deficits in their lower extremities.
The flap based on the lateral calcaneal artery is the most common and useful flap for coverage of exposed Achilles tendon with respect to aesthetic appearance, good functional outcome, minimal donor morbidity, and time of surgery; it is the flap of choice for small- to medium-sized exposed Achilles. Our study's second most commonly used flap was based on the sural artery. This flap can cover medium to larger defects. Similarly, other techniques also had their advantages and disadvantages.
整形外科医生在修复外露跟腱时仍面临诸多挑战。修复此类缺损的几种替代方法包括逆行腓肠神经营养血管皮瓣、腓骨短肌皮瓣、推进皮瓣、跟外侧动脉皮瓣和腓动脉穿支皮瓣。然而，这些技术都各有优缺点。本研究将我们的临床经验与用于外露跟腱的各种重建技术进行了比较。
2023年10月至2024年7月期间，对15例患者的外露跟腱进行了重建。这15例病例根据伤口来源、合并症、手术结果和并发症进行分类，并采用前瞻性研究进行分析。
患者的平均年龄为40岁。所有15例患者对皮瓣手术耐受性良好，无明显并发症；然而，1例采用逆行腓肠神经营养血管皮瓣的患者出现了完全性皮瓣坏死，需要二期进行中厚皮片移植。另有1例患者出现远端皮瓣尖坏死，经二期愈合。1例患者发生感染，通过清创和连续换药得以解决。所有患者下肢均无功能障碍。
就美学外观、良好的功能结果、最小的供区并发症和手术时间而言，基于跟外侧动脉的皮瓣是覆盖外露跟腱最常用且最有效的皮瓣；它是中小型外露跟腱缺损的首选皮瓣。我们研究中第二常用的皮瓣是基于腓肠神经营养血管的皮瓣。该皮瓣可覆盖中到较大的缺损。同样，其他技术也各有优缺点。
