PMC3745097_01
The picture showing the soft tissue and Achilles tendon defect of the right leg after debridement and harvested gracilis muscle
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F1
Thorough debridement of the wound resulted in a 20 cm long x 10 cm wide defect (200 cm2) and the defect was covered with a free gracilis muscle flap [Figure 1].
Follow-up at 2 years showing well settled flap and tip toe standing without any support on both legs
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F2
At 2 years follow-up, we noted that patient was having a good active plantar flexion, was able to stand tip toe on both legs without any support, and had good push off and a near normal gait [Figure 2].
Ultrasound picture showing the tendon and graft interface proximally and distally
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F3
The movement of the ankle and Achilles tendon region was evaluated by using dynamic B-mode ultrasound, which was carried out with patient prone and the probe was kept over the region of reconstruction and the result showed that there is increased echogenic soft-tissue shadow in the deeper aspect of the muscle flap, which is filling the tendon defect suggestive of fatty change and the muscle was found to be merging with the Gastro-soleus myotendinous region proximally and to the residual tendon and to the calcaneum distally, and on active plantar flexion against resistance the muscle graft filling the defect was found to be shortening and transmitting the force of muscle action to the calcaneum [Figure 3].
Magnetic resonance imaging T2-image showing the tendon defect, which is filled by the muscle graft and the deeper part of the muscle graft is in continuity with the proximal myotendinous region and distal Achilles tendon - suggestive of complete graft incorporation
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F4
T2-weighted image showed that there is a tendon defect, which is being filled by the muscle graft and the deeper part of the muscle graft shows fatty change. The cleavage of the graft with the proximal myotendinous region and distal Achilles tendon is not visualised - suggestive of complete incorporation of the graft [Figure 4].