Treatment of extensive aseptic defects in old Achilles tendon ruptures: methods and case reports.

Defect bridging is still problematic in the secondary treatment of Achilles tendon ruptures. Smaller defects can be treated without problems by the well-known standardized methods, whereas other methods have to be applied for treating larger defects. Free transplants with autogenous or exogenous material should be mentioned in this context. Complications are more likely to occur with exogenous material, free transplants from the fascia lata require an additional intervention to remove the transplant from another localization. These methods cannot be applied to achieve reliable restoration of continuity for defects with a length of 10 cm. Therefore, in these special cases, we carry out the tendon transplantation with a free tendon-muscle graft from the triceps surae muscle. We achieved reliable restoration of continuity with complication-free healing of the free transplant in, up to now, three cases, in association with the formation of a strong, functionally high grade scar plate in the area of the tendon.