Fascial flap coverage of Achilles tendon defects

The exposed, often desiccated Achilles tendon presents a difficult wound that cannot always be solved with the use of regional tissue. A series of 15 consecutive patients with wounds associated with previous failed repairs (n = 5), radiation (n = 1), trauma (n = 4), pressure sores (n = 3), and burn contractures (n = 2) is presented. Patients with osteomyelitis of the calcaneus were not included. All were covered with free fascial flaps from parietotemporal or forearm donor sites and skin grafts. There were two partial flap losses. Complications were minimal, and all patients were mobilized and ambulating within 2 months. Average follow-up was 4 years. Those with peripheral vascular insufficiency were revascularized prior to free tissue transfer. Vascularized fascia covered with skin grafts provides the treatment of choice for the localized Achilles tendon exposure not exceeding 10.0 cm. Advantages include (1) provision of thin, pliable tissue that permits gliding, (2) minimal bulk, (3) simultaneous donor- and recipient-site dissections, (4) transfer of mobile tissue that can be wrapped around tendon, and (5) early wound coverage and mobilization.