Médecine et chirurgie du pied


The role of Abraham’s VY flap in the treatment of neglected Achilles tendon rupture Volume 27, issue 1, Mars 2011


Neglected rupture of the Achilles tendon presents a difficult surgical problem because of the retraction of the tendon and consequent loss of its substance. The objective of this study was to evaluate the role of Abraham’s VY tendinous flap in the treatment of such Achilles tendon ruptures. This retrospective study performed over 4 years, from July 2005 to July 2009, examines 16 cases of neglected calcaneal tendon rupture. The mean age of the patients, aged between 30 and 54, was 40 years. The injuries were mainly linked to sporting activity (12 cases). The mean delay between the initial injury and medical treatment was 10 weeks, with a range of 4 to 16 weeks. The diagnosis of rupture was always made entirely on clinical grounds. Surgery was performed in the ventral decubitus position, using a medial para-Achilles tendon approach. The mean loss of substance was estimated at 6 cms, with a range of 5 to 10 cms. The mobilisation of the VY flap facilitated the closure of the gap. In all cases, reinforcement was performed using the tendon of the plantaris muscle. After surgery a non-weight-bearing plaster cast was applied for 6 weeks (in equinus for the first 3 weeks; ankle at right-angles for the last 3 weeks). Thereafter, functional rehabilitation was commenced. Results were assessed according to the clinical and functional criteria. The overall results were excellent in 2 cases (12.5%), good in 12 (75%) and poor in 2 (12.5%). The treatment of neglected rupture of the Achilles tendon is difficult because of the associated substantial loss of tendon substance. However, the involvement of Abraham’s VY flap produces encouraging functional results.