الفهرس 
Anatomy of the legOnly 14 pages are availabe for public view
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Abstract
The Achilles tendon is the largest and strongest tendon in the human body. It plays a vital role in walking, running, or jumping as it pulls on the heel upon flexion of the calf muscles. Due to its anatomic particularities, reconstruction and resurfacing of soft tissue defects of Achilles tendon region is a challenging task to plastic surgeons Skin loss over the Achilles area may results from burns, lacerations, avulsions, contusions, and pressure phenomena such as occur under a cast. Early coverage for these wounds is necessary because nourishment is disrupted when the tendon is exposed, infection and desiccation, either of which can lead to loss of tendon viability and become dry and necrotic.
Flaps are the best option for covering these defects as they are well vascularised, durable reconstruction and also provides a gliding surface for the underlying tendon. Local, regional, distant & free micro vascular flaps are available for cover in these defects. The best available option with the least donor site morbidity has to be chosen to cover these defects. One has to bear in mind that there is no single desired reconstructive option that will suit all defect sizes in this area.
All included patients underwent the standard preoperative preparation for surgery including laboratory and radiological investigations. General and local examinations were done including assessment of defect size, extent of injury, vascularity of the affected limb using color duplex, exposure of other structures other than the Achilles tendon and the integrity of surrounding skin.
The choice of flap was determined by the available uninjured tissue on the donor site, and by the size and location of the defect. According to the defect size after excisional debridement, the posterior tibial perforator artery flap, the peroneal artery perforator
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flap, the lateral supra malleolar artery flap , the reverse sural artery flap, the peroneus brevis muscle flap, and the latissimus dorsi musculocutaneous free flap were performed in our study.
In conclusion, Achilles’ tendon region has several injury mechanisms, which involve defects of the Achilles tendon, skin, and calcaneus. The reconstruction protocols should not be separated. Lateral supra malleolar artery flap, perforator flaps and the distally based peroneus brevis muscle flap are best used for covering small to intermediate sized defects with good results. Reversed sural artery flap can be advocated for covering defects in the Achilles area, as it is successfully used for covering defects that varied in size from small to large defects. The use of free flaps is restricted mainly to complex and wide reconstructions, as it requires advanced procedures and microvascular experience.