Plasty of Achilles region with propeller tendon-fasciocutaneous peroneal artery perforator flap after radical excision of a neglected squamous cell carcinoma

Viorica Mihaluța, Alina Stoian, Rodica Iordăchescu, Elena Pavlovschi, Adrian Cociug, Eleonora Borș, Snejana Smolenschi, Grigore Verega


Squamous cell carcinoma (SCC) is a slow-growing, aggressive skin cancer with tendency for recurrence and metastasis to the lymph nodes and adjacent vital structures. Treatment for SCC is wide excision and reconstruction. Complex defects with tendon or bone exposure require reconstruction with local, pedicled or free flaps, either cutaneous, fascial or tendon-fasciocutaneous, bone or muscle flaps. The aim of the case report is to present the post-oncologic reconstruction of the complex defect of Achilles region using a composite tendon-fasciocutaneos peroneal propeller pedicled perforator flap with anatomic and functional restoration. Case report: a 57-year-old man with diabetes type II for 10 years, presented with a 20-year history of static non-healing ulcer at left Achilles tendon level after a car accident. The biopsy revealed squamous cell carcinoma on the background of chronic inflammation. Wide resection included Achilles tendon and calcaneus bone, with resulting tissue defect of 12x16 cm. Perforator peroneal artery flap with tendon of 11cm length rotated propeller in 180 degree to the distal region provided defect coverage. Skin graft resurfaced the donor site. Postoperative recovery was uneventful, the tendon-fasciocutaneous flap survived entirely with skin graft fully integrated. Conclusions: The tendon-fasciocutaneous peroneal artery perforator flap in pedicled propeller fashion provides good function of the limb with minimum recovery time for oncologic patients. Concomitantly, the cosmetic aspect of the reconstruction makes our choice a valuable choice to resurface complex defects of the Achilles region.


squamous cell carcinoma; Achilles region; tendon-fasciocutaneous peroneal artery perforator; reconstructive surgery; propeller flap

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