Composite Cutaneous Anterolateral Thigh Flap with Rolled Fascia Lata for Tibialis Anterior Tendon Reconstruction

BACKGROUND:Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot become impaired, disrupting patient’s gait. Reported techniques for repair fall into nonoperative (ankle-foot orthosis) or operative (primary closure, tendon transfer, free gracilis) modalities, depending on patient factors, mechanism of injury, and extent of defect. In this report, we outline a novel method of tendon repair and soft tissue coverage for a large defect. METHODS:We present a unique case of traumatic TAT rupture with a failed primary closure yielding a large (>15 cm) defect. The patient presented with a defect spanning the entire anterior compartment of the leg, limiting options for coverage and functional restoration. RESULTS:The patient’s large, chronic defect was successfully repaired via a composite cutaneous anterolateral thigh and a rolled fascia lata free flap. The patient had robust return to function and is able to dorsiflex and invert the foot and ambulate. CONCLUSIONS:The use of this donor site offers a novel, advantageous option for TAT repair. It should be considered for patients with large defects that make other repair methods unfeasible.