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Volume 2, Issue 2, Pages 49-52 (June 2016) The hemisoleus rotational flap provides a novel superior autograft reconstructive option for the treatment of chronic extensor mechanism disruption Jean-Charles Auregan, MD, James D. Lin, MD, MS, Joseph M. Lombardi, MD, Eugene Jang, MD, William Macaulay, MD, Melvin P. Rosenwasser, MD Arthroplasty Today Volume 2, Issue 2, Pages 49-52 (June 2016) DOI: 10.1016/j.artd.2016.01.001 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Intraoperative clinical photograph of the gross defect and retraction of the quadriceps tendon (plus sign). Scar tissue (arrow head) has formed in the void between the quadriceps and patella (arrow). Orientation: proximal: left; distal: right; medial: top; lateral: bottom. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 2 (a) Elevation of the hemisoleus flap (arrow heads). The Achilles tendon (arrow) remains contiguous with the calcaneal block. (b) Care was taken in identifying the perforating vessels from the posterior tibial vasculature (arrowhead). Visible here is the flap consisting of the medial belly of the gastrocnemius (star), the hemisoleus, and its continuity with the calcaneal block (arrow). Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 3 The flap (plus sign) is brought from the posterior compartment of the leg to the anterior compartment of the thigh. The calcaneal block (arrow) is looped through the quadriceps tendon (arrowhead) before being secured to the patella. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 4 The hemisoleus flap (arrowhead) is secured to the quadriceps tendon (5-point star) with #1 FiberWire. The calcaneal block (arrow) will then be anchored in the patella (plus sign) allowing for bone-to-bone healing. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 5 Posterior view of skin incision and hemisoleus flap. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 6 Anterior view of graft passed through quadriceps tendon and docked into patellar trench. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 7 Patient demonstrating active extension against resistance at 3 months postoperative. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 8 Patient walking with cane at 3 months postoperative. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions

Figure 9 Radiograph at 3 months postoperative demonstrating implants in place and healing of calcaneal block to patella. Arthroplasty Today 2016 2, 49-52DOI: (10.1016/j.artd.2016.01.001) Copyright © 2016 The Authors Terms and Conditions