Distally based tenosynovial sheath flap of peroneal tendons for exposed tendo Achilles: Preliminary report of five cases☆

A distally based tenosynovial sheath of peroneal tendons was used as a flap with skin graft to cover the exposed tendo Achilles. The flap has a reliable blood supply being perfused by a constant sizeable musculofascial perforator. Cadaveric dissection with methylene blue dye study has been conducted to prove the rationality and reliability of blood supply. The position of the perforator had been confirmed prior to surgery by a hand-held Doppler. The flap used to cover the exposed Achilles tendon in five cases yielded positive results. To our knowledge, a retrograde flap of this nature is unprecedented though an antegrade flap of similar composition has been described.