Island Adipofascial Flap for Resurfacing of the Achilles Tendon

Satisfactory replacement of soft-tissue defects over the Achilles tendon remains a difficult challenge for plastic surgeons. Flap coverage is vital to preserve an exposed tendon as well as to supply a gliding surface. Ten patients were selected for this study who had sustained exposed Achilles tendons either after trauma or after excision of burn scar. The island adipofascial flap was used based on the most distal two to three septocutaneous perforators of the posterior tibial artery that are located 3.7 to 5.5 cm proximal to the tip of the medial malleolus, as confirmed by my anatomic study. The island adipofascial flap provides a durable and thin coverage for the Achilles tendon, as well as a good vascularized bed for skin grafting.