Soft tissue and tendon reconstruction after Achilles tendon rupture: Adipofascial sural turnover flap associated with cryopreserved gracilis tendon allograft for complicated soft tissue and Achilles tendon losses

Spontaneous Achilles tendon rupture poses a reconstruction problem of great clinical interest because this is the third most common tendon tear 1, and its correction involves the orthopedic surgeon. It occurs mainly in men with a sedentary lifestyle and generally aged between 40 and 50 years, though it can also occur in individuals who exercise regularly and in top-level athletes.Various mechanisms may trigger this lesion and clinical forms such develop form a series of concomitant causes but, generally speaking, Achilles tendon rupture is attributable to direct basic mechanisms, occurring singly or in various combinations.: • excessive stretching of the tendon under tension, as in falling from a considerable height, be it accidentally or in sports such as parachuting; • forced dorsiflexion with a relaxed ankle, as in some of the typical movements of a basketball game; • trauma directly affecting the tendon in tension, as in a soccer or football game. The rupture usually occurs in the ribbon-like portion of the tendon, between 2 and 4 cm from the insertion in the heel, in an area characterized by a poor vascularization, as shown by Langergren’s and Lindholm’ studies 2. Vascularization of the tendon depends strictly on the mesotendon, and the blood supply progressively declines over the years. Repeated injuries in the Achilles tendon area may also reduce the vascular supply to the region, thus facilitating a subsequent tendon tear. The inflammatory repair processes associated with enough to withPervenuto in Redazione Aprile 2005, Accettato per la pubblicazione Luglio 2005. For correspondence: Pier Camillo Parodi, MD, Università di Udine c/o Ospedale “San Michele”, Dipartimento di Chirurgia Plastica Ricostruttiva, Piazza Rodolone 1, 33013 Gemona del Friuli (Udine) (e-mail: [email protected]). Soft tissue and tendon reconstruction after Achilles tendon rupture:Adipofascial sural turnover flap associated with cryopreserved gracilis tendon allograft for complicated soft-tissue tendon losses.A case report and literature review