One-stage reconstruction of Achilles tendon and skin defects by the sliding gastrocnemius musculocutaneous flap without anastomosis.

ABSTRACT

BACKGROUND: Simultaneous defects of Achilles tendon and skin remain a big challenge for clinical surgeons. This article reviews the experience of a one-stage reconstruction of the defects. The sliding gastrocnemius musculocutaneous flap without anastomosis was used and the associated anatomy was studied. METHODS: Fourteen cases of Achilles tendon and skin defects have been treated by the V-Y advancement of the gastrocnemius musculocutaneous flap in our orthopedic center from 1993 to 2006. Results of the pedicle anatomy and the sliding distances of the flap are analyzed with different degrees of knees on 30 cadaver specimens. RESULTS: Twelve cases healed uneventfully. Two cases had partial necrosis on the distal portion of the flap. The follow-up of all the 14 cases ranged from 4 months to 12 years. There was no ankle stiffness, tendon rerupture, or walking inconvenience observed in their daily lives. During the surgery process, the sliding distance of the flap reached (9.2 +/- 0.9 cm) when the knee was flexed by 90 degrees. CONCLUSIONS: For one-stage reconstruction of Achilles tendon and skin defects, the sliding gastrocnemius musculocutaneous flap is advantageous in vascularity, function, and sensation without anastomosis. The harvest of the flap demands familiarity with the anatomy.