Figure 3.

A case of absence of Achilles tendon secondary to an infection of an acute repaired rupture. The patient underwent initial surgery, which included deep debridement, gentamicin-PMMA bead implantation, and intravenous antibiotic therapy, to resolve the infection. Salvage reconstruction was then performed 12 weeks later. (A) A soft tissue defect is visible above the Achilles tendon, and a sural flap is planned for coverage. (B) Following resection of non-viable tissue, a 9 cm gap in the Achilles tendon was identified. A flexor hallucis longus (FHL) transfer was performed and sutured in place first. (C) Intraoperative photograph showing the sutured allograft filling the gap, in conjunction with the FHL transfer. (D) Long-term follow-up revealing functional heel-rise and the donor site of the sural flap covered with a skin graft.