Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap
A 50-year-old gentleman presented to the plastic surgery OPD of our hospital with complains of wound over posterior aspect of right heel for 1 month. He had a history of sudden onset pain and a feeling of ‘give’ while working in the fields 3 months back. His local physician referred him to an orthopaedic colleague who operated upon him twice in a span of 2 months with unfavourable results. Persistence of wound in the Achilles tendon area prompted the patient to seek plastic surgical opinion and hence he visited our OPD. The patient was a farmer by occupation and the sole bread winner of his family. Upon examination there was a 7 × 5 cms wound at the tendo Achilles area. The medial malleolar area was skin grafted and had a small raw area of about 2 × 2 cms near the anterior edge of the graft []. The skin of the medial malleolar area appeared to have been raised as a flap to cover the defect over the tendo Achilles which had necrosed distally later on. The plantar flexion at the ankle joint was extremely weak and the patient was unable to bear his weight on his toes. The patient was counselled regarding the extent and severity of his problems and the options for reconstructing complex tendo Achilles defects. It was decided to offer the patient a free flap reconstruction of the complex defect.