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Simultaneous reconstruction of the Achilles tendon and soft-tissue defect using only a latissimus dorsi muscle free flap

Authors
 Hoon-Bum Lee  ;  Dae-Hyun Lew  ;  Seung-Hoon Oh  ;  Kwan-Chul Tark  ;  Sug-Won Kim  ;  Yoon-Kyu Chung  ;  Young-Hee Lee 
Citation
 PLASTIC AND RECONSTRUCTIVE SURGERY, Vol.104(1) : 111-119, 1999 
Journal Title
PLASTIC AND RECONSTRUCTIVE SURGERY
ISSN
 0032-1052 
Issue Date
1999
MeSH
Achilles Tendon/injuries* ; Achilles Tendon/surgery ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; Soft Tissue Injuries/surgery* ; Surgical Flaps* ; Tendon Injuries/surgery ; Treatment Outcome
Abstract
The combined loss of the Achilles tendon and the overlying soft tissue in the young ambulant patient with expectations of a normal life is a challenging problem. These patients need not only soft tissue but also dynamic and functional reconstruction. Four cases of major defects of the Achilles tendon and overlying soft tissue after trauma are presented. In each case, the tendon and the overlying soft tissues were reconstructed using only a latissimus dorsi muscle free flap and overlying split-thickness skin graft. In conventional methods, evolved in the reconstruction of the Achilles tendon and soft tissue, the size of the defect was a limit. However, this technique can be used to reconstruct an extensive defect, including distal calf muscle to the plantar metatarsal area. In one case, the flap was harvested in a myocutaneous unit, and the skin portion was deepithelialized for the coverage and enough padding on the bony exposure area in reverse position. The purpose of the present study was to reevaluate the potential of denervated muscle flap for a force-bearing conduit as an alternative reconstructive method of the Achilles tendon. The denervated latissimus dorsi muscle in this study eventually experienced the process of atrophy and fibrosis but maintained its original length. Although there remained some atrophic muscle fibers, a fibrosis of the muscle fibers formed a tendon-like fibrous band, and so the action of the posterior calf muscle could be transmitted through the tendon-like fibrotic change of the denervated latissimus dorsi muscle. The advantages of this technique are that (1) it is a single procedure, (2) it is adaptable to a wide range of defect sizes, (3) it allows faster wound healing supported by well-vascularized tissues, (4) it produces satisfactory function of the ankle joint and a padding effect, and (5) it produces good contour of the posterior calf to the sole and an acceptable donor-site morbidity.
Full Text
https://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=ovft&AN=00006534-199907000-00017&PDF=y
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Plastic and Reconstructive Surgery (성형외과학교실) > 1. Journal Papers
Yonsei Authors
Lew, Dae Hyun(유대현)
Tark, Kwan Chul(탁관철)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/172591
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