{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T23:43:44Z","timestamp":1776210224552,"version":"3.50.1"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Handchir Mikrochir Plast Chir"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Infection after Achilles tendon (AT) repair can lead to defects in both the\ntendon and the surrounding soft tissue. In such cases, a two-stage surgical\napproach is generally adopted, with soft tissue reconstruction performed\ninitially, followed by secondary tendon reconstruction. A reverse sural\nartery flap (RSAF) after AT repair is not commonly performed due to\npotential damage to the flap pedicle. This study aims to evaluate the\nclinical outcomes of simultaneous flexor hallucis longus tendon (FHLT)\ntransfer and RSAF to treat soft tissue and tendon defects resulting from\ninfection after AT repair.<\/jats:p>\n                  <jats:p>We reviewed 20 patients who had undergone one-stage reconstruction of AT and\nsoft tissue defects resulting from infection after AT repair using FHLT\ntransfer and RSAF between October 2012 and October 2022, with a minimum of a\n1-year postsurgical follow-up. Surgical outcomes were assessed based on the\nsuccess of the flap, recurrence of infection, and tendon re-rupture.\nClinical evaluation included visual analog scale (VAS) score, ankle range of\nmotion, and patient-reported components of the American Orthopaedic Foot and\nAnkle Society (AOFAS) score (maximum of 68 points).<\/jats:p>\n                  <jats:p>All flaps were successful. The mean size of the flap was 7.2\u00d74.1\ncm2. There was no recurrence of infection or tendon\nre-rupture. The mean VAS and AOFAS scores were 0.5 and 64.6, respectively.\nThe mean ankle joint range of motion was 13.5\u00b0 for dorsiflexion and 35\u00b0 for\nplantar flexion.<\/jats:p>\n                  <jats:p>One-stage reconstruction with FHLT transfer and RSAF is a safe and effective\nsurgical method in patients with tendon and soft tissue defects after AT\nrepair.<\/jats:p>","DOI":"10.1055\/a-2681-8656","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T22:44:53Z","timestamp":1761086693000},"page":"180-186","source":"Crossref","is-referenced-by-count":0,"title":["Safety of One-Stage Reconstruction of Achilles Tendon and Soft Tissue\nDefects Resulting from Infection After Achilles Tendon Repair using Flexor\nHallucis Longus Tendon Transfer and Reverse Sural Artery Flap"],"prefix":"10.1055","volume":"58","author":[{"given":"Jae Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Orthopedic Surgery, Yeson Hospital, Bucheon-si, Korea (the Republic\nof)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1926-3228","authenticated-orcid":false,"given":"KiHyeok","family":"Ku","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong,\nGangdong-gu, Korea (the Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang Min","family":"Kang","sequence":"additional","affiliation":[{"name":"Graduate School, College of Medicine, Kyung Hee University,\nDongdaemun-gu, Korea (the Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darryl D","family":"D'Lima","sequence":"additional","affiliation":[{"name":"Orthopedic Research and Education, Scripps Health, San Diego, United\nStates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong Hun","family":"Baek","sequence":"additional","affiliation":[{"name":"Orthopedic Research and Education, Scripps Health, San Diego, United\nStates"},{"name":"Orthopedic Surgery, Kyung Hee University Hospital, Dongdaemun-gu, Korea\n(the Republic of)"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1097\/00006534-199206000-00018","article-title":"Skin island flaps supplied by the vascular axis of the sensitive superficial\nnerves: anatomic study and clinical experience in the leg","volume":"89","author":"A C Masquelet","year":"1992","journal-title":"Plast Reconstr Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1097\/SAP.0b013e31819516cc","article-title":"Single stage reconstruction of ruptured tendoachilles tendon with skin cover\nusing distally based superficial sural artery flap","volume":"63","author":"S V Abhyankar","year":"2009","journal-title":"Ann Plast Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/SAP.0b013e3182853d6c","article-title":"Single-stage reconstruction of achilles tendon rupture with flexor hallucis\nlongus tendon transfer and simultaneous free radial fasciocutaneous forearm\nflap","volume":"70","author":"R S Nazerali","year":"2013","journal-title":"Ann Plast Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1177\/107110079301400803","article-title":"Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon\ntransfer","volume":"14","author":"K L Wapner","year":"1993","journal-title":"Foot Ankle"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1302\/0301-620X.97B2.34521","article-title":"Reconstruction of defects involving the Achilles tendon and local soft tissues:\na quick solution for a lingering problem","volume":"97-B","author":"J Soons","year":"2015","journal-title":"Bone Joint J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1097\/00006534-199810000-00044","article-title":"One-stage reconstruction of an infected skin and Achilles tendon defect with a\ncomposite distally planned lateral arm flap","volume":"102","author":"J V Berthe","year":"1998","journal-title":"Plast Reconstr Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1055\/s-2006-947148","article-title":"Reconstruction of the achilles tendon and overlying skin defect with a medical\nplantar flap and tensor fasciae latae graft","volume":"16","author":"Y Taniguchi","year":"2000","journal-title":"J Reconstr Microsurg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1002\/micr.22481","article-title":"Radial forearm flap plus Flexor Carpi Radialis tendon in Achilles tendon\nreconstruction: Surgical technique, functional results, and gait analysis","volume":"35","author":"M Innocenti","year":"2015","journal-title":"Microsurgery"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2325967118774302","DOI":"10.1177\/2325967118774302","article-title":"Infection and Rerupture After Surgical Repair of Achilles Tendons","volume":"6","author":"T R Jildeh","year":"2018","journal-title":"Orthop J Sports Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.fcl.2019.04.008","article-title":"Management of Complications of Achilles Tendon Surgery","volume":"24","author":"J Liles","year":"2019","journal-title":"Foot Ankle Clin"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2016","DOI":"10.2106\/00004623-200211000-00017","article-title":"Rerupture and deep infection following treatment of total Achilles tendon\nrupture","volume":"84","author":"A Pajala","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.otsr.2012.07.009","article-title":"Salvage technique for postoperative infection and necrosis of the Achilles\ntendon","volume":"98","author":"E Fourniols","year":"2012","journal-title":"Orthop Traumatol Surg Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1302\/0301-620x.84b3.11559","article-title":"Chronic rupture of tendo Achillis. Long-term results of operative management\nusing polyester tape","volume":"84","author":"A G Jennings","year":"2002","journal-title":"J Bone Joint Surg Br"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1177\/03635465020300041701","article-title":"Quantitative review of operative and nonoperative management of achilles tendon\nruptures","volume":"30","author":"J Wong","year":"2002","journal-title":"Am J Sports Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1302\/0301-620X.67B3.3997956","article-title":"The myth of muscle balance. A study of relative strengths and excursions of\nnormal muscles about the foot and ankle","volume":"67","author":"R L Silver","year":"1985","journal-title":"J Bone Joint Surg Br"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"794","DOI":"10.3113\/FAI.2008.0794","article-title":"Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis\ntendon transfer: clinical outcome and MRI findings","volume":"29","author":"F Hahn","year":"2008","journal-title":"Foot Ankle Int"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.fas.2009.10.006","article-title":"Immediate free tissue transfer for coverage of Achilles tendon injury or\nreconstruction","volume":"16","author":"J M Baden","year":"2010","journal-title":"Foot Ankle Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2598","DOI":"10.2106\/JBJS.I.01578","article-title":"Reconstruction of the Achilles tendon with a composite anterolateral thigh free\nflap with vascularized fascia lata: a case report","volume":"92","author":"P Duhamel","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1002\/micr.22490","article-title":"The composite anterolateral thigh flap for achilles tendon and soft tissue\ndefect reconstruction with tendon repair by fascia with double or triple folding\ntechnique","volume":"35","author":"S K Youn","year":"2015","journal-title":"Microsurgery"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1055\/s-0032-1306367","article-title":"Reconstruction of the Achilles tendon and overlying soft tissue by free\ncomposite anterolateral thigh flap with vascularized fascia lata","volume":"28","author":"P Houtmeyers","year":"2012","journal-title":"J Reconstr Microsurg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1012","DOI":"10.1097\/00006534-199404001-00016","article-title":"The distally based superficial sural artery flap","volume":"93","author":"M Hasegawa","year":"1994","journal-title":"Plast Reconstr Surg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1772","DOI":"10.1097\/PRS.0000000000005652","article-title":"The Anterolateral Thigh Flap for Achilles Tendon Reconstruction: Functional\nOutcomes","volume":"143","author":"D Ehrl","year":"2019","journal-title":"Plast Reconstr Surg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1016\/j.bjps.2017.02.022","article-title":"Objective sensory and functional outcomes at the donor site following\nendoscopic-assisted sural nerve harvest","volume":"70","author":"D P Butler","year":"2017","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1173 e1171","DOI":"10.1016\/j.jhsa.2023.03.009","article-title":"Long-Term Donor-Site Morbidity Following Entire Sural Nerve Harvest for\nGrafting","volume":"48","author":"H R Shah","year":"2023","journal-title":"J Hand Surg Am"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1177\/1071100718809066","article-title":"AOFAS Position Statement Regarding Patient-Reported Outcome Measures","volume":"39","author":"H B Kitaoka","year":"2018","journal-title":"Foot Ankle Int"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/j.fas.2023.04.004","article-title":"A systematic review of the patient reported outcome measures utilized in level 1\nrandomized controlled trials involving achilles tendon ruptures","volume":"29","author":"C Pearsall","year":"2023","journal-title":"Foot Ankle Surg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"52","DOI":"10.11138\/jts\/2016.4.1.052","article-title":"Outcome evaluation after Achilles tendon ruptures. A review of the\nliterature","volume":"4","author":"P Spennacchio","year":"2016","journal-title":"Joints"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e012884","DOI":"10.1136\/bmjopen-2016-012884","article-title":"American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score: a\nstudy protocol for the translation and validation of the Dutch language\nversion","volume":"7","author":"E M Van Lieshout","year":"2017","journal-title":"BMJ Open"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.jisako.2023.07.003","article-title":"The completely patient-reported version of the American Orthopaedic Foot and\nAnkle Society (AOFAS) score: A valid and reliable measurement for ankle\nosteoarthritis","volume":"8","author":"LD A Paget","year":"2023","journal-title":"J ISAKOS"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1053\/j.jfas.2006.12.002","article-title":"Reliability and validity of the subjective component of the American Orthopaedic\nFoot and Ankle Society clinical rating scales","volume":"46","author":"T Ibrahim","year":"2007","journal-title":"J Foot Ankle Surg"}],"container-title":["Handchirurgie \u00b7 Mikrochirurgie \u00b7 Plastische Chirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2681-8656.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T22:45:14Z","timestamp":1776206714000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2681-8656"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,21]]},"references-count":30,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2026,4,14]]},"published-print":{"date-parts":[[2026,4]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2681-8656","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0722-1819","1439-3980"],"issn-type":[{"value":"0722-1819","type":"print"},{"value":"1439-3980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,21]]}}}