Flap cut and wound cover

The patient lay in a supine position, with the affected limb elevated for 1-2 min to facilitate venous drainage. Hemostasis was achieved using a balloon tourniquet, followed by a thorough debridement of the area. As shown in Figure 2, an incision was made at the posterior edge of the flap, the superficial layer of the deep fascia was separated backward, and the perforator of the posterior tibial artery was identified based on the previously marked points. After the deep fascia was incised to meticulously release the perforator vessels, an additional incision was then executed along the anterior edge of the flap, and the perforator vessels were freed along the direction of the main trunk of the posterior tibial artery. The flap was advanced in a distal, antegrade fashion to cover the skin defect in the Achilles tendon. Finally, the flap and the donor site were sutured, and a drainage tube was placed at a lower level to facilitate fluid evacuation and promote healing.

Schematic diagram of flap design and suture.