{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T06:52:22Z","timestamp":1773211942764,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T00:00:00Z","timestamp":1763510400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Reconstruction of complex Achilles tendon defects involving both the tendon and the overlying soft tissues represents a challenging scenario for plastic surgeons. In this report, we present an innovative technique of hybrid total Achilles tendon reconstruction combining acellular dermal matrix placement to restore the full\u2010thickness continuity of the tendon and free latissimus dorsi (LD) flap coverage to allow graft integration and simultaneously resurface the soft tissue defect, ultimately leading to lower limb salvage. Between August 2023 and February 2024 two patients received microsurgical hybrid reconstruction of complex defects, measuring 10\u2009\u00d7\u200910\u2009cm and 17\u2009\u00d7\u200914\u2009cm, respectively, involving the lower third of the leg and the Achilles tendon region, due to trauma with multiple previous failed surgeries and sarcoma resection. The full\u2010thickness continuity of the tendon was reconstructed by use of an XCM BIOLOGIC Tissue Matrix (DePuy Synthes, Johnson &amp; Johnson), measuring 6\u2009and 10\u2009cm long, respectively, folded in a three\u2010layered tridimensional structure to recreate the shape and function of a new tendon. Subsequently, a free myo\u2010cutaneous LD flap, was used to wrap and revascularize the neo\u2010tendon and resurface the soft tissue defect. In both patients the flaps healed uneventfully, and neo\u2010tendon integration was documented by MRI examination. The follow\u2010up was uneventful. Long\u2010term functional evaluation showed almost normal tendon excursion with both patients walking without assistance. The proposed hybrid approach may be a good alternative and innovative solution for the reconstruction of complex Achilles tendon defects consequent to trauma or oncological resection. Such results are more than promising for future studies on large series of patients.<\/jats:p>","DOI":"10.1002\/micr.70146","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T08:43:57Z","timestamp":1763541837000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hybrid Total Achilles Tendon Reconstruction Combining Acellular Dermal Matrix Placement and Free Latissimus Dorsi Flap Coverage: A Report of Two Cases"],"prefix":"10.1002","volume":"45","author":[{"given":"Beniamino","family":"Brunetti","sequence":"first","affiliation":[{"name":"Operative Research Unit of Plastic, Reconstructive and Aesthetic Surgery Fondazione Policlinico Universitario Campus Bio\u2010Medico  Rome Italy"},{"name":"Research Unit of Plastic Surgery, Department of Medicine and Surgery Universit\u00e0 Campus Bio\u2010Medico di Roma  Rome 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