Comparative Clinical Outcomes of Reconstructive Flap Techniques for Exposed Achilles Tendon: A Prospective Study

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Orthopedic Surgery

Background:

• Reconstructing exposed Achilles tendons presents significant challenges for plastic surgeons.
• Multiple flap options exist, including reverse sural artery flap, peroneus brevis flap, propeller flap, lateral calcaneal artery flap, and peroneal artery perforator flap.
• Each technique possesses unique advantages and limitations.

Purpose of the Study:

• To compare clinical experiences with various reconstructive techniques for exposed Achilles tendon defects.
• To evaluate the efficacy and outcomes of different flap options in Achilles tendon reconstruction.

Main Methods:

• A prospective study analyzed 15 cases of exposed Achilles tendon reconstruction between October 2023 and July 2024.
• Cases were classified by wound origin, comorbidities, surgical outcomes, and complications.
• Data were collected and analyzed to assess the performance of different reconstructive methods.

Main Results:

• All 15 patients tolerated flap procedures well, with no significant functional deficits.
• One patient experienced complete flap necrosis (reverse sural flap), requiring skin grafting.
• Minor complications included distal tip necrosis (healed by secondary intention) and one infection (resolved with debridement).

Conclusions:

• The lateral calcaneal artery flap is recommended for small- to medium-sized exposed Achilles tendons due to excellent aesthetics, function, minimal donor site morbidity, and shorter surgery time.
• The sural artery flap is a viable option for medium to larger defects.
• All discussed flap techniques have specific benefits and drawbacks, requiring careful consideration for individual patient cases.