An Exposed Achilles Tendon Reconstructed Using a Perifascial Areolar Tissue Graft From the Thigh in an Open Tibial Fracture

CASE: A 20-year-old man sustained a Gustilo-Anderson type IIIB open tibial shaft fracture with Achilles tendon exposure after a motorcycle accident. Early flap surgery was not feasible because of coronavirus disease 2019 restrictions. The initial debridement, external fixation, and negative pressure wound therapy failed to generate sufficient granulation. Perifascial areolar tissue, a thin layer of loose connective tissue located between the deep fascia and the deep layer of subcutaneous fat, was harvested from the thigh and grafted onto the defect, thereby enabling successful full-thickness skin grafting. At 3 years, bone union had been achieved without infection or ankle motion limitation. CONCLUSION: Perifascial areolar tissue may be an alternative when early flap coverage is not possible.