Raymond Shi Liang Yii1, Siew Cheng Chai2, Hamidah Mohd Zainal2, Normala Basiron2

1Department of Surgery, Plastic & Reconstructive Surgery Unit, University of Malaya, Kuala Lumpur, Malaysia
2Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

Keywords: Achilles tendon, anterolateral thigh flap, combined tendocutaneous defect, compound-free flap, reconstruction, sensate, vascularized fascia lata.


Combined tendocutaneous defect of Achilles tendon remains a complex reconstructive challenge whereby both the soft tissue coverage and tendon reconstruction have to be considered to achieve a good functional and aesthetic outcome. A 14-year-old boy who sustained an open right calcaneum fracture (Gustilo-Anderson IIIB) with a transected Achilles tendon and huge skin defect from motorcycle wheel spoke injury was admitted. The Achilles tendon repair site broke down following initial surgical debridement and primary repair, resulting in a sizeable combined tendocutaneous defect. Simultaneous soft tissue coverage and tendon defect reconstruction using composite sensate free anterior lateral thigh (ALT) fasciocutaneous flap with vascularized fascia lata was performed subsequently. The vascularized fascia lata was tubularized to wrap the native proximal stump of Achilles tendon and secured using the modified Krakow suturing technique. The distal end of tubularized fascia lata was, then, secured by drilling across right calcaneum bone, passing the suture transosseously and screwed. He led an uneventful postoperative recovery with satisfactory functional and aesthetic outcomes at one year of follow-up. In conclusion, the present case demonstrates the reliability of this technique and its advantages over other flap choices in reconstruction of a huge combined tendocutaneous defect.

Citation: Yii RSL, Chai SC, Zainal HM, Basiron M. Single-stage reconstruction of a traumatic tendocutaneous defect of the Achilles using free composite anterolateral thigh flap with vascularized fascia lata. Jt Dis Relat Surg 2022;33(3):673-679.

Author Contributions

Idea/concept, design, critical review: R.S.L.Y., S.C.C., H.M.Z., N.B.; Control/supervision: N.B., S.C.C., H.M.Z.; Data collection and/or processing, literature review, writing the article: R.S.L.Y.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.