SLR - August 2009 - Alissa Duncan
Reference:
Michlits, W., Gruber, S., Windhofer, C., Macheiner, P., Walsh, M., Papp, C. (2008). The Journal of Trauma Injury, Infection, and Critical Care. 65(6) 1459-1562.
Scientific Literature Review
Reviewed by: Alissa Duncan, DPM
Residency Program: OCPM-UHHS Richmond Medical Center
Podiatric Relevance:
This study provides information on the treatment of soft tissue defects overlying the Achilles tendon.
Methods:
Prior to performing the procedure on patients, the authors performed an anatomic study using 12 cadaver feet. These cadaver feet were used to study the vascular supply and radius of mobilization for the abductor hallucis muscle. Six male patients between 40 and 77 years of age were included in this report. The arterial supply and size of the abductor hallucis muscle were studied with use of the color coded Duplex sonography using a 5 to 13 MHz linear array scan head. In all patients a debridement was performed first to examine the extent of the defect overlying the Achilles tendon. In two cases the ruptured Achilles tendon was repaired. The abductor hallucis muscle was dissected from the insertion being careful to identify and preserve the medial plantar artery and any of its muscular branches. The muscle was then dissected free from the medial border of the calcaneus. The extended muscle flap was covered with a split thickness skin graft.
Results:
The use of super extended abductor hallucis muscle flaps were successfully reconstructed and provided the patient with good anatomic shape. Six weeks following surgery all patients with no Achilles tendon rupture were fully mobile, with Achilles tendon rupture requiring repair after 12 weeks.
Conclusions:
The super extended abductor hallucis muscle flap could represent an alternative to the use of free flaps for these injuries.