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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 2,
186-188.
doi: 10.1302/0301-620X.90B2.20101 Copyright © 2008 by British Editorial Society of Bone and Joint Surgery Successful treatment of a chronically infected and necrotic tendo Achillis in a diabetic with excision, flexor hallucis longus transfer and split-skin graftingC. J. Pearce, MRCS, Member of the Faculty of Sport and Exercise Medicine (MFSEM) (UK), Specialist Registrar in Trauma & Orthopaedic Surgery1; S. Sexton, MRCS, MFSEM (UK), Specialist Registrar in Trauma & Orthopaedic Surgery1; D. Gerrard, MBBS, FRCS (Gen), Consultant Vascular Surgeon1; A. Hatrick, MRCP, FRCR, Consultant Radiologist1; and M. Solan, BSc (Hons), FRCS(Tr & Orth), Consultant Orthopaedic Surgeon2
1 Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. Correspondence should be sent to Mr C. J. Pearce at 98 Princes Road, Richmond, Surrey TW10 6DH, UK; e-mail: chris.pearce{at}doctors.org.uk
Chronic infections and ulceration around the tendo Achillis are difficult to manage. Split-skin grafts do not survive even on healthy exposed tendon. Refractory cases may require plastic surgical intervention with the use of free flaps. Patients with significant vascular disease are not suitable for such techniques. Flexor hallucis longus tendon transfer is an established treatment for chronic ruptures of the tendo Achillis. We report the successful treatment of an infected tendo Achillis with excision and reconstruction with flexor hallucis longus transfer. The muscle belly of this tendon allowed later skin grafting while the tendon transfer provided good functional recovery.
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