PMC6609348_01
Photograph of the first patient visit 39 days after initial injury. Achilles tendon was re-ruptured with skin necrosis around it.
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He ultimately presented to our department for reconstructive surgery using a free flap 39 days after the initial injury (Figure 1).
Intraoperative photographs (a) After debridement of soft tissue and the Achilles tendon. (b) Design of the flap. (c) TFL was sutured with Achilles tendon. (d) After the operation.
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Wide debridement resulted in a large combined Achilles tendon (7 cm long) and overlying skin defect (5.5 x 11 cm) (Figure 2(a)). The ALT flap with a 6.5 x 13 cm skin island without fascia and TFL musculofascial flap with an 11-cm length of iliotibial fascia were elevated from the right thigh (Figure 2(b)).
Six months after the operation. (a) He could stand on a toe of operated foot. (b) plantar flexion was 45 degree. (c) Dorsiflexion was 10 degree.
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Six months postoperatively, he could stand on a toe of the operated foot without help (Figure 3(a,b)). Function at the ankle was good (Figure 3(c,d) and he had no disability in his daily life.