Achilles tendon reconstruction following excision of a malignant peripheral nerve sheath tumour: Evaluation at five years follow-up☆

Summary 

The case of a 16-year-old male, who presented with a malignant peripheral nerve sheath tumour in his right ankle, is reported. Following initial biopsy, a wider excision was performed resulting in a large skin and soft tissue defect and an 8cm gap in the Achilles tendon. A novel technique was used to reconstruct the Achilles comprising free tendon autografts of peroneus brevis and fascia lata. Skin cover was achieved using a 20×9cm parascapular free flap. The patient made an excellent functional recovery and remains disease-free after five years.

Combined loss of the Achilles tendon and the overlying soft tissue poses a difficult reconstructive challenge. The advantages of the technique described are: it is a single-staged procedure, the reconstructed tendon was of sufficient strength to allow the patient return to competitive hurling, the parascapular flap restored good contour and the donor site can be closed primarily.

Keywords: Malignant peripheral nerve sheath tumour, Sarcoma, Achilles tendon reconstruction, Parascapular free flap