Combined free tissue transfer for the management of composite achilles defects: Functional outcomes and patient satisfaction following thigh-based vascularized reconstruction with a neotendon construct

Michael V. Defazio, Kevin D. Han, Matthew L. Iorio, Christopher E. Attinger, John S. Steinberg, Paul J. Kim, Laura Nemets, Karen K. Evans

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Background Functional outcomes and quality-of-life measures following salvage reconstruction of composite Achilles/posterior leg defects are limited. We present our experience with combined Achilles defect reconstruction utilizing free tissue transfer with vascularized neotendon constructs. Methods Between 2011 and 2012, six patients underwent vascularized reconstruction of complex Achilles defects by a single surgeon. Demographic and functional data were collected for each patient. Subjective evaluation and quality-of-life measures were obtained preoperatively and postoperatively using American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot and SF-36 scores. Early and late complications were noted for each case. Results All defects were reconstructed utilizing vascularized composite free tissue from the thigh. Average soft tissue defect was 76.7 cm2 (range, 40-90 cm2) with a tendon gap of 7.8 cm (range, 5-10 cm). Mean follow-up was 17 months (range, 15-23 months). Flap survival was 100%. Overall range of motion of the reconstructed side was 82% of the unaffected side (48.2 degrees vs. 59 degrees, p = 0.004). Average percent increase in AOFAS and SF-36 scores were 71% (54 vs. 93, p = 0.0005) and 22% (86 vs. 104, p = 0.003), respectively. Operative revision was required for two patients with delayed-onset soft tissue infections and one donor site hematoma. Distal flap ischemia was managed with hyperbaric oxygen therapy in one patient. Functional and esthetic outcomes were judged good to excellent by all patients. Conclusions Free tissue transfer with vascularized tendon reconstruction is a viable option for combined Achilles tendon/posterior leg defects, as both functional and quality-of-life measures appeared to be significantly improved at 1-year follow-up.

Original languageEnglish (US)
Pages (from-to)431-440
Number of pages10
JournalJournal of Reconstructive Microsurgery
Volume30
Issue number6
DOIs
StatePublished - Jul 2014
Externally publishedYes

Fingerprint

Thigh
Patient Satisfaction
Ankle
Quality of Life
Tendons
Orthopedics
Foot
Leg
Hyperbaric Oxygenation
Soft Tissue Infections
Achilles Tendon
Articular Range of Motion
Esthetics
Hematoma
Ischemia
Demography
Tissue Donors
Survival

Keywords

  • Achilles tendon defects
  • composite tissue transfer
  • functional outcomes
  • patient satisfaction
  • quality-of-life measures

ASJC Scopus subject areas

  • Surgery

Cite this

Combined free tissue transfer for the management of composite achilles defects : Functional outcomes and patient satisfaction following thigh-based vascularized reconstruction with a neotendon construct. / Defazio, Michael V.; Han, Kevin D.; Iorio, Matthew L.; Attinger, Christopher E.; Steinberg, John S.; Kim, Paul J.; Nemets, Laura; Evans, Karen K.

In: Journal of Reconstructive Microsurgery, Vol. 30, No. 6, 07.2014, p. 431-440.

Research output: Contribution to journalReview article

Defazio, Michael V. ; Han, Kevin D. ; Iorio, Matthew L. ; Attinger, Christopher E. ; Steinberg, John S. ; Kim, Paul J. ; Nemets, Laura ; Evans, Karen K. / Combined free tissue transfer for the management of composite achilles defects : Functional outcomes and patient satisfaction following thigh-based vascularized reconstruction with a neotendon construct. In: Journal of Reconstructive Microsurgery. 2014 ; Vol. 30, No. 6. pp. 431-440.
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abstract = "Background Functional outcomes and quality-of-life measures following salvage reconstruction of composite Achilles/posterior leg defects are limited. We present our experience with combined Achilles defect reconstruction utilizing free tissue transfer with vascularized neotendon constructs. Methods Between 2011 and 2012, six patients underwent vascularized reconstruction of complex Achilles defects by a single surgeon. Demographic and functional data were collected for each patient. Subjective evaluation and quality-of-life measures were obtained preoperatively and postoperatively using American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot and SF-36 scores. Early and late complications were noted for each case. Results All defects were reconstructed utilizing vascularized composite free tissue from the thigh. Average soft tissue defect was 76.7 cm2 (range, 40-90 cm2) with a tendon gap of 7.8 cm (range, 5-10 cm). Mean follow-up was 17 months (range, 15-23 months). Flap survival was 100{\%}. Overall range of motion of the reconstructed side was 82{\%} of the unaffected side (48.2 degrees vs. 59 degrees, p = 0.004). Average percent increase in AOFAS and SF-36 scores were 71{\%} (54 vs. 93, p = 0.0005) and 22{\%} (86 vs. 104, p = 0.003), respectively. Operative revision was required for two patients with delayed-onset soft tissue infections and one donor site hematoma. Distal flap ischemia was managed with hyperbaric oxygen therapy in one patient. Functional and esthetic outcomes were judged good to excellent by all patients. Conclusions Free tissue transfer with vascularized tendon reconstruction is a viable option for combined Achilles tendon/posterior leg defects, as both functional and quality-of-life measures appeared to be significantly improved at 1-year follow-up.",
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T1 - Combined free tissue transfer for the management of composite achilles defects

T2 - Functional outcomes and patient satisfaction following thigh-based vascularized reconstruction with a neotendon construct

AU - Defazio, Michael V.

AU - Han, Kevin D.

AU - Iorio, Matthew L.

AU - Attinger, Christopher E.

AU - Steinberg, John S.

AU - Kim, Paul J.

AU - Nemets, Laura

AU - Evans, Karen K.

PY - 2014/7

Y1 - 2014/7

N2 - Background Functional outcomes and quality-of-life measures following salvage reconstruction of composite Achilles/posterior leg defects are limited. We present our experience with combined Achilles defect reconstruction utilizing free tissue transfer with vascularized neotendon constructs. Methods Between 2011 and 2012, six patients underwent vascularized reconstruction of complex Achilles defects by a single surgeon. Demographic and functional data were collected for each patient. Subjective evaluation and quality-of-life measures were obtained preoperatively and postoperatively using American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot and SF-36 scores. Early and late complications were noted for each case. Results All defects were reconstructed utilizing vascularized composite free tissue from the thigh. Average soft tissue defect was 76.7 cm2 (range, 40-90 cm2) with a tendon gap of 7.8 cm (range, 5-10 cm). Mean follow-up was 17 months (range, 15-23 months). Flap survival was 100%. Overall range of motion of the reconstructed side was 82% of the unaffected side (48.2 degrees vs. 59 degrees, p = 0.004). Average percent increase in AOFAS and SF-36 scores were 71% (54 vs. 93, p = 0.0005) and 22% (86 vs. 104, p = 0.003), respectively. Operative revision was required for two patients with delayed-onset soft tissue infections and one donor site hematoma. Distal flap ischemia was managed with hyperbaric oxygen therapy in one patient. Functional and esthetic outcomes were judged good to excellent by all patients. Conclusions Free tissue transfer with vascularized tendon reconstruction is a viable option for combined Achilles tendon/posterior leg defects, as both functional and quality-of-life measures appeared to be significantly improved at 1-year follow-up.

AB - Background Functional outcomes and quality-of-life measures following salvage reconstruction of composite Achilles/posterior leg defects are limited. We present our experience with combined Achilles defect reconstruction utilizing free tissue transfer with vascularized neotendon constructs. Methods Between 2011 and 2012, six patients underwent vascularized reconstruction of complex Achilles defects by a single surgeon. Demographic and functional data were collected for each patient. Subjective evaluation and quality-of-life measures were obtained preoperatively and postoperatively using American Orthopaedic Foot and Ankle Score (AOFAS) Ankle-Hindfoot and SF-36 scores. Early and late complications were noted for each case. Results All defects were reconstructed utilizing vascularized composite free tissue from the thigh. Average soft tissue defect was 76.7 cm2 (range, 40-90 cm2) with a tendon gap of 7.8 cm (range, 5-10 cm). Mean follow-up was 17 months (range, 15-23 months). Flap survival was 100%. Overall range of motion of the reconstructed side was 82% of the unaffected side (48.2 degrees vs. 59 degrees, p = 0.004). Average percent increase in AOFAS and SF-36 scores were 71% (54 vs. 93, p = 0.0005) and 22% (86 vs. 104, p = 0.003), respectively. Operative revision was required for two patients with delayed-onset soft tissue infections and one donor site hematoma. Distal flap ischemia was managed with hyperbaric oxygen therapy in one patient. Functional and esthetic outcomes were judged good to excellent by all patients. Conclusions Free tissue transfer with vascularized tendon reconstruction is a viable option for combined Achilles tendon/posterior leg defects, as both functional and quality-of-life measures appeared to be significantly improved at 1-year follow-up.

KW - Achilles tendon defects

KW - composite tissue transfer

KW - functional outcomes

KW - patient satisfaction

KW - quality-of-life measures

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U2 - 10.1055/s-0034-1370339

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