Reconstruction of a Composite Heel Defect Using Achilles Tendon Allograft and Latissimus Dorsi Free Flap: Case Report and Literature Review.

[BACKGROUND] Composite heel defects involving the Achilles tendon and overlying soft tissue are rare and technically demanding. Successful management requires restoration of tendon continuity and durable coverage. We reviewed the literature and presented a representative case to illustrate current strategies.

[METHODS] A literature review of 28 studies that reported outcomes of Achilles tendon reconstruction with concomitant soft tissue coverage was performed. Tendon restoration techniques(allografts, autografts, vascularized grafts) and flap types (muscle and fasciocutaneous) were analyzed for functional recovery, complication rates, and donor-site morbidity. Additionally, we report the case of a 14-year-old woman with a 7-cm Achilles tendon defect and full-thickness heel soft tissue loss. Reconstruction was performed using a cadaveric tendon allograft with a calcaneal bone block combined with a latissimus dorsi free flap.

[RESULTS] The literature demonstrates comparable range-of-motion outcomes between vascularized and nonvascularized tendon grafts, whereas allografts were associated with lower adhesion rates (15%) compared with vascularized grafts (22%). Muscle flaps, particularly latissimus dorsi, were preferred for large defects due to their bulk and pliability, whereas fasciocutaneous flaps offered superior contour for smaller defects. In our case, the patient achieved 10 degrees of dorsiflexion, 50 degrees of plantarflexion, and normal gait and shoe wear, without the need for secondary debulking.

[CONCLUSIONS] A combined allograft-latissimus dorsi approach aligns with published evidence, providing immediate structural integrity, reliable coverage, and predictable remodeling. This technique expands the reconstructive algorithm for extensive Achilles-heel defects, particularly in pediatric patients.