Introduction: Complex wounds of the lower extremity with concomitant Achilles tendon injury can pose a particular reconstructive challenge. An option for these patients is the reverse sural artery fasciocutaneous flap. It is an attractive alternative because in a single-step, the flap elevation affords Achilles tendon exposure. Consequently, the use of this flap yields significant time and resource savings for both reconstructive teams.

Method: Our case series involved three consecutive patients who presented to a single institution. All patients presented with Achilles tendon injuries, either with rupture or severe equinas deformity, with concomitant chronic complex soft tissue defects. The reverse sural artery flap was planned in conjunction with the orthopedics service to facilitate their approach for Achilles tendon repair.

Results: Flap survival was 100% with no flap necrosis noted. The Achilles repair was performed successfully in all cases. The mean time for flap elevation and Achilles exposure was 43[37–52] minutes. Total operative time including subsequent orthopedic procedures and definitive flap inset and donor site coverage was 287[211-347] minutes. There was one case of delayed wound healing which was resolved with conservative management.

Conclusion: The reverse sural artery fasciocutaneous flap is a durable, efficient option for simultaneous Achilles tendon reconstruction and wound coverage. The flap elevation provides the necessary exposure for the orthopedic reconstruction. In our experience, the reverse sural artery fasciocutaneous flap affords a practical method to address two reconstructive challenges with a combined orthoplastic approach.
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