# Comparative Clinical Outcomes of Reconstructive Flap Techniques for Exposed Achilles Tendon: A Prospective Study

## TL;DR

This study compares different surgical techniques for repairing exposed Achilles tendons and finds the lateral calcaneal artery flap to be the most effective.

## Contribution

The study provides a comparative analysis of reconstructive flap techniques for Achilles tendon exposure based on clinical outcomes.

## Key findings

- The lateral calcaneal artery flap showed the best results in terms of aesthetics, function, and minimal complications.
- One reverse sural flap case resulted in complete necrosis requiring additional surgery.
- The sural artery flap was effective for medium to large defects but had some complications.

## Abstract

Background: Plastic surgeons continue to face considerable challenges while reconstructing exposed Achilles tendon. Several alternatives for repairing such defects include the reverse sural artery flap, peroneus brevis flap, propeller flap, lateral calcaneal artery flap, and peroneal artery perforator flap. However, each of these techniques has its pros and cons. This study compares our clinical experience to various reconstructive techniques for exposed Achilles tendon.

Methods: Fifteen individuals had their exposed Achilles tendon reconstructed between October 2023 and July 2024. These fifteen cases were classified based on the origin of the wound, comorbidities, operational results, and complications, which were analyzed using a prospective study.

Results: The average age of the patients was 40. All 15 patients tolerated the flap procedure well without significant complications; however, one patient with a reverse sural flap developed complete flap necrosis and required secondary split-thickness skin grafting. One more patient had distal tip necrosis and healed with secondary intention. One patient developed an infection, which was resolved by debridement and consecutive dressings. None of the patients had any functional deficits in their lower extremities.

Conclusions: The flap based on the lateral calcaneal artery is the most common and useful flap for coverage of exposed Achilles tendon with respect to aesthetic appearance, good functional outcome, minimal donor morbidity, and time of surgery; it is the flap of choice for small- to medium-sized exposed Achilles. Our study’s second most commonly used flap was based on the sural artery. This flap can cover medium to larger defects. Similarly, other techniques also had their advantages and disadvantages.