A Comparative Study between Outcomes of Random Pattern vs Axial Pattern Local Fasciocutaneous Flap for Tendoachilles Region Defect of Small and Medium Size

Abstract

Introduction: Tendoachilles region defects are challenging to reconstruct due to their anatomical peculiarities like limited vascularity and mobility of the skin. Trauma due to falls or RTAs, wound dehiscence post tendoachilles repair, pressure ulcers, burn injuries, excision of tumors, etc., are the various causes leading to tendoachilles region defects. These defects can be small (<30 cm²), medium (30-90 cm²), or large (> 90 cm²). For medium and small defects, there is no better flap. In this study, we compare axial pattern and random pattern fasciocutaneous flaps for tendoachilles region defects of small and medium size.

Materials and methods: A prospective interventional study of 8 patients was conducted from 1^st January 2022 to 31^st May 2023 between two groups: axial pattern and random pattern for coverage of tendoachilles region defects. Random flap included bipedicle and v-y advancement flaps, whereas perforator (axial pattern) flap included peroneal artery perforator-based propeller and pedicled flap and reverse sural artery perforator flap.

Results: Age ranged from 18 to 60 years with the majority being middle-aged men (37.5 %). The most common cause for tendoachilles region defect is trauma due to fall or RTA. We found out that there is no significant difference in the length of hospital stay or duration of procedure between random pattern or axial pattern local fasciocutaneous flap. Our series demonstrated a low complication rate and good functional outcomes for patients.

Conclusion: Local fasciocutaneous flaps are reliable and simple solutions for covering small to moderate soft tissue defects overlying the Achilles Tendon, with acceptable functional and cosmetic outcomes. There is no difference in outcome whether a random pattern or axial pattern flap is used.