Reconstruction of an Open Achilles Tendon Rupture With a Large Soft Tissue Defect Using an Achilles Tendon Allograft and Distally Based Sural Artery Neurocutaneous Flap: A Case Report.

Achilles tendon ruptures are categorized as acute or chronic based on the timing of diagnosis, with chronic ruptures presenting considerable surgical challenges. This case report details the management of a 58-year-old man who presented with a chronic open Achilles tendon rupture accompanied by a large soft tissue defect. The injury, caused by a sheet metal cutting accident, was further complicated by wound necrosis and infection. Surgical management involved reconstruction of the Achilles tendon using an allograft, along with defect coverage using a distally based sural artery neurocutaneous flap. Postoperative outcomes were favorable, with marked improvements in both pain and functional capacity. At six months postoperatively, the patient exhibited complete graft integration, satisfactory functional recovery, and a return to daily activities without signs of ankle instability. This case demonstrates the efficacy of tendon allograft reconstruction combined with vascularized flap coverage in managing complex Achilles tendon injuries with extensive tissue loss. Further research is warranted to evaluate the long-term success of this approach.