The new distal soleus adiposal pull-through composite flap for reconstruction of defects overlying the Achilles tendon: the anatomy and clinical experience.

Several human studies show positive signals, while research methods and sample sizes continue to develop.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Defects overlying the Achilles tendon are common in patients after immobilization, particularly in those with vascular disease. Conservative wound management and local or free flaps are well-known treatments. Rapid recovery is important, especially in elderly patients; therefore, we looked for an alternative local surgical technique. We introduced for the first time the distal soleus adiposal pull-through flap for covering limited defects over the Achilles tendon. In 10 cadaveric feet, the vascular supply of the sub-Achilles adiposal tissue was studied to clarify the possible clinical utilization. We introduced this novel technique in 6 clinical cases. First, debridement was carried out and the Achilles tendon was divided in the midline. Next, the underlying soleus muscle and sub-Achilles adiposal tissue were carefully dissected. After detaching the flap distally, it was pulled through the Achilles tendon and fixed into the defect. Forty-eight hours later, the flap was covered with meshed split-thickness skin graft. Our anatomic findings showed a sufficient blood supply of the sub-Achilles adiposal tissue by perforators from the soleus muscle, even after ligation of all perforators from the posterior tibial artery and fibular artery. This novel technique allowed a successful defect reconstruction with good functional and cosmetic outcome in all our cases. Two weeks after operat

Evidence level

Several human studies show positive signals, while research methods and sample sizes continue to develop.

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