Surgical reconstruction of the fascia lata and posterior tibial artery perforator flap to treat children with simultaneous injury to the Achilles tendon and heel skin

Children with simultaneous injury to the Achilles tendon and heel skin remain a challenge for clinicians. The purpose of this study is to evaluate a combined surgical procedure involving use of the fascia lata to reconstruct the Achilles tendon, and the posterior tibial artery perforator flap to cover the accompanying heel skin injury. Between February 2010 and February 2013, 8 children (3 females and 5 males) between 3 and 12 years of age, with a median age of 7.5 years, were hospitalized in the First Affiliated Hospital of Shantou University Medical College. All injuries involved damage to an Achilles tendon and heel skin. In all patients, the fascia lata was transplanted to reconstruct the Achilles tendon and the posterior tibial artery perforator flap transplanted to cover the skin injury. Hospitalization was 11 to 15 days (mean 13.5 days). Local necrosis (15% of the area) occurred in 1 flap, but healed after changing dressing. All other flaps survived well. At follow-up after 1 to 2 years, all children had recovered good plantar-flexion and supported their weight while walking. Use of the Arner-Lindholm standard to rate clinical efficacy revealed that of the 8 cases, 6 cases showed excellent recovery and 2 were good, with 0 cases ranking moderate or poor. The excellent and good rate was 100%. Child patients with Achilles tendon injury accompanied by heel skin injury are still a challenge for clinicians. Use of the fascia lata, combined with a posterior tibial artery perforator flap, to reconstruct the Achilles tendon and heel skin for children is a feasible, safe, effective method, faster than other methods for recovery, and should be widely applied in the clinic.