Reconstruction of Achilles Tendon Rupture with Combined V-Y Plasty and Gastrocnemius-Soleus Fascia Turndown Graft

A reconstructive technique for treatment of Achilles tendon rupture with an extensive defect is presented. The primary goal of this salvage procedure is to create functional length and anatomic continuity among muscle, tendon, and bone. The procedure uses a combination of fascial advancement techniques: the V-Y advancement and the gastrocnemius-soleus fascia turndown graft. In this technique, the inverted “V” inscribed on the proximal gastrocnemius fascia is partially elevated from the underlying soleus and twisted 180° on itself to augment the repair. Advancing the musculotendinous junction and creating a turndown graft provide substantial length. This combined technique allows the surgeon to repair ruptures with segmental defects greater than 10 cm in length.