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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2023; 08(02): e114-e119
DOI: 10.1055/s-0043-1777097
Original Article

Single-Stage Extensor Digitorium Tendon Reconstruction, Including Overlying Soft Tissue Defects of the Foot Dorsum with a Composite-Free Anterolateral Thigh Flap

Trần Thiết Sơn 
1   Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
2   Department of Plastic Reconstructive and Aesthetic Surgery, University of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
3   Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
,
Lê Hồng Phúc 
4   Department of Surgery, University of Medicine and Pharmacy, Hue University, Thua Thien Hue, Vietnam
,
Phan Tuấn Nghĩa 
1   Department of Plastic and Reconstructive Surgery, Hanoi Medical University, Hanoi, Vietnam
3   Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, Hanoi, Vietnam
,
Nguyễn Đinh Minh 
2   Department of Plastic Reconstructive and Aesthetic Surgery, University of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
5   Department of Plastic Reconstructive and Aesthetic Surgery, E Hospital, Hanoi, Vietnam
,
Nguyễn Thanh Tùng 
6   Department of Plastic Reconstructive and Aesthetic Surgery, Thai Nguyen Central Hospital, Thai Nguyen, Vietnam
,
Nguyễn Ngọc Tuấn
2   Department of Plastic Reconstructive and Aesthetic Surgery, University of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
5   Department of Plastic Reconstructive and Aesthetic Surgery, E Hospital, Hanoi, Vietnam
,
Lương Thanh Tú 
2   Department of Plastic Reconstructive and Aesthetic Surgery, University of Medicine and Pharmacy, Hanoi National University, Hanoi, Vietnam
5   Department of Plastic Reconstructive and Aesthetic Surgery, E Hospital, Hanoi, Vietnam
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Abstract

Background Loss of the extensor tendon with overlying soft tissue remains a complex reconstructive challenge. Successful reconstruction combines tendon repair with defect coverage by soft tissue flaps, meets the goals of approaching functionality, and achieves an esthetic result.

Patients and Methods From June 2016 to June 2022, our center submitted six patients to a one-stage procedure correcting the extensor tendon and skin defect using a composite-free anterolateral thigh (ALT) flap with fascia lata (FL).

Results The ALT skin paddle was from 10 × 8 cm to 26 × 13 cm, and all flaps included vascularized FL with an average of 12 × 9.5 cm, which was split and folded to reconstruct as a tendon. The extensor digitorium brevis tendon defects were reconstructed by fascia sheets in all patients. One patient had additional reconstruction of the extensor hallucis longus tendon. All the flaps survived completely, and no complication was reported. All patients received rehabilitation therapy starting in the third week postoperatively. The mean follow-up was 33.67 months (range, 10–60). The mean arc of ankle rotation between dorsiflexion and plantar flexion was 49.20 degrees (range, 40–55 degrees). After reconstruction, our patients showed good functional results, and these patients could walk, climb stairs, tiptoe again without support, and regular footwear could be worn.

Conclusion A composite-free ALT flap with vascularized FL is a reasonable option for coverage of the extensor tendon and overlying soft tissue defects. It helps reduce the surgical risk and hospitalization time and provokes faster recovery and rehabilitation.

Level of Clinical Evidence Case studies, Level 4.

Keywords

anterolateral thigh flap - fascia lata flap - foot dorsum - extensor tendon defects - soft tissue defect

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. This study was approved by the Research Ethics Committee of our institution.


Informed Consent

Informed consent was obtained from all individual participants included in the study. The authors confirm that human research participants provided informed consent for publication of the images in [Figs. 1] and [2].




Publication History

Received: 06 April 2023

Accepted: 31 July 2023

Article published online:
04 December 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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