PMC9647665_01
(a) Preoperative localization of ALT cutaneous perforators; (b) Right heel defect with skin defect of 12x6 cm and tendon
defect of 6 cm; (c) Left anterolateral thigh flap with skin paddle dimension of 15.0x6.5 cm and tubularized fascia lata; (d) Left
anterolateral thigh flap showing tubularized fascia lata, vascular pedicle, and lateral femoral cutaneous nerve (arrow).
ALT: Anterior lateral thigh.
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F1
Doppler ultrasound and marked (Figure 1a). Debridement of right heel wound resulted in Achilles tendon defect of 6 cm long and overlying skin defect of 12.0x6.0 cm (Figure 1b). The ALT fasciocutaneous flap, with a skin paddle dimension of 15.0x6.5 cm (Figure 1c), and lateral extension of fascia lata sheet with a dimension of 15.0x7.0 cm (Figure 2a), were raised from the left thigh. The lateral cutaneous femoral nerve of left thigh was harvested together with the flap (Figure 1d).
. (a) Vascularized fascia lata with dimension of 15.0x7.0 cm; (b) Microanastomoses between flap pedicles and posterior
tibial vessels; (c) Neo-tendon. The fascia lata was tubularized to wrap the native proximal stump of Achilles tendon and secured
using modified Krakow suturing technique and 3 cm-long distal end of tubularized fascia lata was secured and transosseously and
screwed; (d) Immediate postoperative external flap appearance.
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F2
The ALT fasciocutaneous flap, with a skin paddle dimension of 15.0x6.5 cm (Figure 1c), and lateral extension of fascia lata sheet with a dimension of 15.0x7.0 cm (Figure 2a), were raised from the left thigh. End-to-end microvascular anastomoses were performed between the lateral circumflex femoral vessels and posterior tibial vessels at the recipient site proximal to the upper edge of pre-existing wound (Figure 2b). Distal end of tubularized fascia lata was, then, secured by drilling across right calcaneum bone, passing the suture transosseously and screwed (Figure 2c). The flap recipient and donor site were closed primarily (Figure 2d).
Postoperative one year (a) Right heel flap healed well with acceptable scar appearance. (b) Patient is able to perform
heel rise without difficulty. (c) Preserved normal right ankle contour with optimal thickness of flap allowing comfortable footwear.
(d) Acceptable donor site scar appearance.
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F3
The patient was able to walk with normal gait, stand on his toes (Figure 3b), and returned to his daily ambulating activities without any support after four months postoperatively. The aesthetic results of both donor and recipient areas were optimal with preserved normal right ankle contour and optimal thickness of flap allowing comfortable footwear (Figure 3a-d).
(a) Range of right ankle dorsiflexion from 0 to 20 degree, similar to the contralateral side; (b) Range of right ankle
plantarflexion from 0 to 50 degree, similar to the contralateral side.
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F4
At one year of follow-up, the active range of motion (ROM) of right ankle joint was similar to the contralateral side, that was, 0 to 20 and 0 to 50 degrees for dorsiflexion and plantarflexion, respectively (Figure 4a, b).