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Gastocnemius turndown repair augmented with transfer of the posterior tibial tendon
5%
181/3592
Gastocnemius turndown repair augmented with transfer of the extensor digitorum longus
3%
96/3592
Gastocnemius turndown repair augmented with transfer of the flexor hallucis longus
85%
3056/3592
Reconstruction with hamstring autograft
6%
207/3592
Primary repair with the foot in maximal plantarflexion followed by a gradual stretching program
1%
33/3592
Select Answer to see Preferred Response
Tendon loss is a complication associated with secondary ruptures of a repaired Achilles tendon and chronic Achilles tendon ruptures. Gastrocnemius turndown utilizes a slip of the central third of the gastrocnemius tendon to bridge the gap. Flexor hallicus longus (FHL) is the preferred tendon transfer to augment tissue loss due to its proximity and vascularity. Answer choice 5 is not a prudent option given the risk of equinus contracture and recurrent rupture. Wapner et al conducted a case review of 7 patients who underwent FHL augmentation for chronic Achilles tendon rupture. Results included no surgical complications, a small but functionally insignificant decrease in ankle and great toe range of motion, and clinical satisfaction of all 7 patients. Chiodo et al summarize the AAOS clinical guidelines for evaluation and treatment of acute Achilles tendon ruptures predicated upon an extensive review of the literature. Illustrations A-C depict the steps for a gastrocnemius turn-down flap consisting of a V-Y incision with the arms of the "V" measuring 6cm.
4.4
(24)
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