Microvascular skin coverage in wounds that expose the Achilles tendon

Authors

  • Baltazar Barrera-Mera Department of Physiology. Faculty of Medicine. UNAM. CDMX. Mexico
  • Israel Salgado-Adame Department of General Surgery, Hospital Lic. Adolfo Lopez Mateos, I.S.S.S.T.E., Mexico.
  • Obed Horacio Grajeda-Chávez Department of Surgery, Central North Hospital PEMEX, CDMX, Mexico
  • Jazmín Danaé Chávez-Hernández Department of Surgery, Central North Hospital PEMEX, CDMX, Mexico
  • Cuauhtémoc Aguilar-Barragán Department of Surgery, Central North Hospital PEMEX, CDMX, Mexico
  • Ana Lilia Abundez-Pliego Department of Surgery, PEMEX General Hospital, Ciudad del Carmen, Mexico
  • Yuri Jiménez-Caprielova Department of Surgery, General Hospital # 50, I.M.S.S., San Luis Potosi. Mexico
  • Leonel Dalain Hernández-Arteaga Department of Surgery, General Regional Hospital #1, I.M.S.S., Morelia, Mexico
  • Román Alberto de la Rosa Llergo Department of Surgery. Hospital Angeles Villahermosa. Mexico
  • José Enrique Pérez-López Department of Surgery. High Specialty Regional Hospital Zumpango. Mexico
  • Alan Isaac Valderrama-Treviño Department of Surgery, Central North Hospital PEMEX, CDMX, Mexico

DOI:

https://doi.org/10.18203/2320-6012.ijrms20214731

Keywords:

Achilles tendon surgery, Microsurgery, Free radial forearm flap, Vascularized flexor carpi radialis tendon, Free anterolateral thigh flap, Skin coverage, flap, Compound defect, Composed flaps

Abstract

Achilles tendon rupture is one of the most frequent tendon ruptures. Surgical intervention is the best option, but it has a high rate of complications leading to skin infections and necrosis. Extensive and aggressive debridement is necessary, producing tendon exposure and large skin defects. There are many alternatives for the skin coverage of the Achilles tendon, like sequential closures, vacuum assisted closure, local flaps, regional flaps, and more recently and efficiently microsurgery flaps. Skin defects in the Achilles tendon region have many peculiarities in comparison with other parts of the body: it is a zone that is always under mechanical stress due to footwear, this is why it must be highly resistant but thin. Its coverage must have sensitive properties, endure tendon gliding and allow early rehabilitation. Sometimes tendon reinforcement or creation or a neo tendon will be needed. For fulfilling these requirements free flaps by microsurgery are the only option in 90% of the cases. In this review article, we analyze three of the most frequently used free flaps in reconstructive medicine for complex Achilles tendon defects; free radial forearm flap, free radial forearm flap with vascularized flexor carpi radialis tendon and free anterolateral thigh (ALT) flap with vascularized fascia lata. This choice will be determined by the number of tissues involved, size of the defect, etiology of the defect, overall condition of the affected extremity and quality of neighboring tissues.

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Published

2021-11-26

How to Cite

Barrera-Mera, B., Salgado-Adame, I., Grajeda-Chávez, O. H., Chávez-Hernández, J. D., Aguilar-Barragán, C., Abundez-Pliego, A. L., Jiménez-Caprielova, Y., Hernández-Arteaga, L. D., de la Rosa Llergo, R. A., Pérez-López, J. E., & Valderrama-Treviño, A. I. (2021). Microvascular skin coverage in wounds that expose the Achilles tendon. International Journal of Research in Medical Sciences, 9(12), 3733–3738. https://doi.org/10.18203/2320-6012.ijrms20214731

Issue

Section

Review Articles