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  • ALT in combination with triple-rolled TFL for reconstruction of a complex tendoachilles defect: technical details and rehabilitation regime

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Surgery
ALT in combination with triple-rolled TFL for reconstruction of a complex tendoachilles defect: technical details and rehabilitation regime
  1. Zahra Ahmed1,
  2. Hannah Cook2,
  3. Meera Anadkat2,
  4. Lydia Ioannidi2,
  5. Helen Marmery3 and
  6. Dariush Nikkhah1,2
  1. 1Division of Surgery and Interventional Science, University College London, London, UK
  2. 2Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
  3. 3Royal Free London NHS Foundation Trust, London, UK
  1. Correspondence to Zahra Ahmed; zahra.ahmed.20{at}ucl.ac.uk

Abstract

A fit man in his 60s presented with an infected Achilles tendon (AT) following two failed repairs for a traumatic rupture. Initial debridement of necrotic tissue resulted in a large soft tissue defect requiring robust coverage. Following aggressive wound management, an anterolateral thigh flap was elevated with tensor fasciae latae (TFL) which was triple-rolled to provide soft tissue coverage and tendon reconstruction.

The flap remained healthy and was monitored with a flow coupler device. Initially, the foot was placed in plantarflexion before gradually increasing the angle to neutral and a thermoplastic splint was used to offload pressure on the flap. Following 1 month of non-weight-bearing, gentle mobilisation began. Three months postoperatively, the patient could walk, had resumed indoor cycling and demonstrated a comparable heel raise with the contralateral side. MRI showed a taut TFL attached to the distal AT and ultrasound showed a smoothly gliding TFL.

  • Rehabilitation medicine
  • Physiotherapy (rehabilitation)
  • Tendon rupture
  • Surgery
  • Plastic and reconstructive surgery

https://doi.org/10.1136/bcr-2023-258355

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    Footnotes

    • Twitter @hannahisabelcook

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content—ZIHA, HC, LI, HM and DN. The following author gave final approval of the manuscript—DN.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.