Tensor fasciae latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularized fascia

The surgical management of large defects of the Achilles tendon and overlyi ng skin is very demanding and necessitates, as a rule, a Free vascularized graft. The ideal characteristics of a thin laver of skin and a strong tendo n component, combined with a reliable blood supply and minimal morbidity at the donor site, have only been partially met by all previous grafts used i n this situation. The authors performed reconstructions in five patients with large defects o f the Achilles tendon and overlying Skin try using a perforator flap derive d from the tensor fasciae latae flap. A vascularized skin-subcutis-fascia l ata flap could be raised by dissecting out two to three perforating arterie s through the tensor fasciae latae muscle to the ascending branch of the la teral circumflex femoral artery; the muscle was left in situ in the process . All the flaps took well without complications. At final examination after a n average of 20 months, the reconstructed Achilles tendon showed good funct ional results, although there was a 50 to 70 percent reduction in power dur ing plantar flexion when compared with the normal side. A very good aesthet ic result could be obtained after a debulking operation was performed on th e skin nap.