Circumferentially Exposed Achilles Tendon Wound Reconstruction Using Free Anterolateral Thigh Flap With Vascularized Fascia Lata Wrapping

Resection of a giant plexiform fibroma on the lower leg of a 75-year-old woman with neurofibromatosis type 1 resulted in an extensive skin soft tissue defect and a circumferentially exposed wound involving the Achilles tendon. As secondary reconstruction was performed after a waiting period to rule out a malignant peripheral nerve sheath tumor using histopathological examination, the major challenge was to prevent adhesion of the Achilles tendon to the surrounding granulation tissue, in addition to reconstructing the extensive skin soft tissue defect. We overcame this problem by using a free anterolateral thigh flap with the vascularized fascia lata wrapping technique. A free composite anterolateral thigh flap with fascia lata is a recognized method for primary reconstruction of the Achilles tendon and overlying soft tissue defects. We selected this method not for reconstruction of the Achilles tendon defect, but to prevent adhesion of the tendon to the surrounding tissue. The exposed Achilles tendon was circumferentially wrapped with vascular fascia lata. The postoperative range of motion of the ankle joint was 5 degrees in dorsiflexion and 45 degrees in plantar flexion. Although dorsiflexion was impaired, the patient was able to walk unassisted and had no problems in daily life. The appearance around the ankle joint was good. We report the novel use of a free anterolateral thigh flap with vascularized fascia lata in periapical Achilles tendon reconstruction.