Reconstruction of the Achilles Tendon after Tumor Excision with Flexor Hallucis Longus Tendon Transfer

Reconstruction following excision of tumors of the Achilles tendon poses a challenge to the treating surgeon. Described techniques for restoration of plantarflexion in the setting of an unrepairable tendon include the use allograft, autograft, tendon transfer, and free flap. In tumor surgery, options may be limited as total tendon resection may be necessary leaving little or no residual tendon to which allograft or autograft can be secured. Patient factors such as a radiated field or need for timely commencement of adjuvant therapies may make the use of avascular allografts or microvascular anastomosis for free flap application disadvantageous. This report describes two cases in which patients underwent removal of large neoplasms involving the Achilles tendon and reconstruction of the tendon with flexor hallucis longus (FHL) tendon transfer and primary closure. Both patients had good outcomes as relates to function and cosmesis. Though minor wound complications arose, neither the patient required flap coverage. Both wounds healed with local wound care. We believe the described technique is a safe, effective adaptation of the FHL transfer described for neglected Achilles tears and is useful in the management of patients with plantarflexion deficits following tumor resection.