Early Functional Outcomes After Single-Stage Achilles Tendon Reconstruction Using Free Anterolateral Thigh Flap With Tubularized Fascia Lata

Abstract

Background:

Achilles tendon injury with extensive soft tissue loss presents challenges to lower extremity (LE) reconstruction with functionally favorable results. The use of a free anterolateral thigh (ALT) flap incorporating a tubularized fascia lata (FL) segment offers a reconstructive option for these complex cases. This study evaluates the early outcomes of microsurgical reconstruction for Achilles tendon and soft tissue defects.

Methods:

A retrospective review of patients requiring LE free tissue transfer (FTT) between 2012 and 2023 was performed. All patients included had Achilles tendon defects and underwent reconstruction using an ALT flap with tubularized FL. Demographics, comorbid conditions, baseline functionality, reconstructive details, and wound characteristics were collected. Primary outcomes were flap success, return to functional ambulation, and complication rate.

Results:

Twenty-two patients underwent single-stage FTT for both soft tissue coverage and Achilles tendon reconstruction. The average age was 46.9 ± 16.1 years, with a median Charlson Comorbidity Index of 0 (IQR: 2). Average wound size was 80.6 ± 40.1 cm². All patients (n = 22, 100.0%) were ambulatory preoperatively. Flap success rate was 95.5% (n = 21). Twelve patients (55%) had long-term physical therapy follow-up. At a median of 7.6 months (IQR: 5.2), median ankle active range of motion (AROM) was 15 degrees (IQR: 7) for dorsiflexion (DF) and 43.5 degrees (IQR: 10) for plantarflexion (PF). Eleven (50%) patients had normal DF AROM (91.7%), and 9 (81.8%) patients had normal PF AROM. At a median of 2.3 months (IQR: 2.8), all 22 patients (100.0%) returned to full weightbearing and ambulation. Median follow-up time was 6.9 months (IQR: 16.5). These findings reflect early functional outcomes, with a median follow-up period of less than 1 year.

Conclusion:

The ALT free flap with an attached FL is a functional reconstructive technique for Achilles tendon injury in the setting of large soft tissue defects. The composite free flap provides consistent operative success with robust early patient return to ambulation and weightbearing. Further evaluation into patient-reported outcomes can provide additional understanding of functionality.