Single-Stage Reconstruction of Soft-Tissue Defects Including the Achilles Tendon Using the Dorsalis Pedis Arterialized Flap Along with the Extensor Digitorum Brevis as Bridge Graft

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Abstract
Open ruptures of the Achilles tendon with loss of the tendon and the overlying skin are very difficult to treat. They pose the problems of (1) combating infection, (2) providing soft-tissue cover, and (3) bridging the gap in the tendon. They are generally managed as multi-staged procedures. Once the infection is brought under control with debridement and antibiotics, skin cover is provided by local transposition flaps, distant pedicle flaps, or free-tissue transfer with microvascular anastomoses. The tendon itself is repaired later by one of the conventional techniques. More recently, composite free-tissue transfers repairing the skin and tendon in a single stage have been reported. We describe a simple and very reliable procedure using a dorsalis pedis island flap which provides a vascularized, innervated musculotendinous unit (i.e., extensor digitorum brevis) to bridge the gap in the Achilles tendon and thin, mobile skin and fascia to close the defect in the skin. Two cases are presented, including the technical details, advantages, and limitations of this procedure.

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