flexor hallucis longus (FHL) tendon graft

The flexor hallucis longus (FHL) tendon transfer is a surgical technique used to strengthen a damaged Achilles tendon. This procedure involves relocating the FHL tendon, which normally controls big toe flexion, to support the compromised Achilles tendon.
  • Administration of anesthesia
  • Incisions to access the Achilles tendon and calcaneus (heel bone). Any bony protrusions or diseased tissue are removed from the affected area.
  • Surgeon locates and severs the FHL tendon, disconnecting it from its original attachment at the big toe.
  • A small tunnel is drilled into the calcaneus near the Achilles tendon attachment site.
  • The FHL tendon is then rerouted through this tunnel.
  • The transferred tendon is trimmed and reinforced before being secured within the calcaneus using an anchor or screw.
  • In some cases, the tendon may be sutured alongside the Achilles tendon for additional stability.

After closing the incisions, the foot is immobilized in a cast or protective boot.

This surgical approach is particularly useful for reinforcing Achilles tendon repairs, especially in cases of chronic ruptures or when additional support is needed

Process

The surgical illustration depicts the final stage of the procedure, where the Achilles tendon repair is being augmented. At this point, the end of the Achilles tendon is being secured to the flexor hallucis longus (FHL) tendon graft using FiberWire sutures. This additional step provides extra stability to the repair.

The advantage of using the FHL tendon as a graft is clearly visible in the illustration. It has a substantial muscle belly, which is beneficial for the healing process. Over the course of 6 to 12 months post-surgery, this graft undergoes revascularization, effectively filling the gap between the two ends of the repaired Achilles tendon.

This particular scene was chosen for illustration because it showcases a crucial moment in the surgery that highlights the innovative use of the FHL tendon in reinforcing the Achilles tendon repair. It also allows for the visualization of the anatomical relationships and surgical techniques involved in this complex procedure.