Immediate tendon Achilles reconstruction with composite palmaris longus grafts

Full-thickness defects of the posterior heel constitute a continuing reconstructive challenge due to a relative lack of regional tissues in this area and the inherent avascularity of the tendo-Achilles. Wound closure and tendon reconstruction with composite flaps can potentially accelerate healing, reduce scarring, and improve tendon function. In 2 patients, a radial forearm-palmaris longus composite free flap was used to reconstruct full-thickness defects of the heal and tendo-Achilles. Rapid healing and return of function were obtained without significant donor site disability.