IDEAS AND INNOVATIONS Wrap technique to cover exposed Achilles tendon with the soleus muscle Tolga Türker 1 & Kevin Lawson 1 & Ethan Erik Larson 2 Received: 1 January 2016 /Accepted: 8 June 2016 /Published online: 15 June 2016 # Springer-Verlag Berlin Heidelberg (outside the USA) 2016 Abstract Numerous etiologies may lead to loss of Achilles tendon coverage. Currently, multiple coverage options are available to the reconstructive surgeon; however, described techniques may not meet every patient’ s need. In this case report, we describe the use of a simple technique, utilizing the soleus to cover exposed Achilles by folding the muscle circumferentially around the tendon. The technique described is a local option, creates minimum morbidity, does not require microsurgical skills, and can be performed quickly. Level of Evidence: Level V, therapeutic study. Keywords Achilles . Exposed tendon . Local flap . Skin graft . Muscle flap Introduction Multiple etiologies such as trauma, burn, infection, pressure ulcers, and surgical resection may lead to the loss of Achilles tendon coverage [1–3]. Uniquely, a soft tissue defect around the ankle, such as loss of Achilles coverage, requires a recon- struction which is both durable enough to withstand weight bearing and thin enough to allow for the use of footwear [4, 5]. Free flaps from the trunk or upper and lower extremities, as well as local rotational flaps, have been well described for this specific coverage [1]. Many of these previously described techniques, however, may be too risky for patients with mul- tiple comorbidities. Additionally, depending on the degree of soft tissue loss, a number of these techniques may not be available. In this study, we describe the use of a simple tech- nique utilizing the soleus to cover exposed Achilles by folding the muscle circumferentially around the tendon. Surgical technique First attention is given to the preparation of the Achilles ten- don. This begins with thorough debridement of any residual infected, necrotic, or contaminated tissue. If the tendon sheath is still partially intact, it should be removed. Next, the Achilles tendon is simply folded onto itself with underlying soleus muscle, and the tendon and the muscle are then imbricated together using 2-0 synthetic absorbable suture with a taper needle (Fig. 1). The tendon can be folded onto itself with the underlying soleus muscle at the mid and distal level of the tendon; however, the very proximal portion of the tendon cannot be folded because proximally, the tendon is confluent with gastrocnemius. Folding the tendon proximally therefore results in bulky structure. When maximum distal fold is achieved, the proximal portion of the tendon is simple super- ficially debrided until the gastrocnemius muscle is reached. The thickness of the tendon that will be removed proximally prior to reaching healthy muscle is about 1 mm. The folded soleus muscle and proximal portion of the gas- trocnemius muscle need skin coverage. The coverage can be performed during the same surgery or if there is a concern about the infection, the coverage can be accomplished as a separate procedure. Negative pressure therapy can be applied in the interim. * Tolga Türker drtolgaturker@gmail.com 1 Department of Orthopaedic Surgery, The University of Arizona, 1609 N Warren Ave, Bld 220, Rm 108, Tucson, AZ 85719, USA 2 Department of Plastic and Reconstructive surgery, The University of Arizona, Tucson, AZ, USA Eur J Plast Surg (2017) 40:57–60 DOI 10.1007/s00238-016-1214-6