Myocutaneous flap shows promise in pediatric Achilles tendon repair

By Liam Davenport, medwireNews Reporter

A free partial latissimus dorsi myocutaneous flap can be used for the treatment of severe contracture of the Achilles tendon and posterior ankle in children, and achieves satisfactory form and function, the results of a case series indicate.

L Zhu, from Jiao Tong University School of Medicine, in Shanghai, China, and colleagues note: "In the rapid growth stage of childhood, the untreated severe contracture of the Achilles will limit the development of the tendon and the ankle… In addition, the different limb lengths can gradually make the pelvis oblique. Hence, reconstruction of Achilles tendon is important and highly desirable, especially in childhood."

They add: "In our experience, the free partial latissimus dorsi musculocutaneous flap offers enough skin to cover the Achilles tendon without requiring a skin graft at the donor or recipient sites of a growing child."

For the study, five children aged 8 to 12 years who suffered soft-tissue injuries involving the posterior ankle that resulted in severe contractures of the Achilles tendon, leading to equinus deformity and abnormal gait, underwent reconstructive surgery. The procedure involved the use of a free partial latissimus dorsi myocutaneous flap with conventional Z-plasty Achilles tendon lengthening.

The mean time from the initial injury to the first visit to the clinic was 11.4 months, and the children were followed up for an average of 32.2 months. Flap survival was 100%, and all of the children had good functional outcomes, with resolution of the equinus deformity and a return to normal gait by 6 months' follow up, the researchers report in the Journal of Plastic, Reconstructive and Aesthetic Surgery,.

At the 1-month postoperative follow up, all of the parents complained about the appearance of the donor site and three children were dissatisfied. However, there was only one scar complaint at 6 months. Furthermore, the team states that, after 1 year, the denervated muscle flap atrophied, which gave a good aesthetic results.

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