Treatment Of The Achilles Tendon Re-rupture With Cutaneous Deficiency After The Tendon Repair

Objective：Achilles tendon rupture and then complicating the necrotic ofskin loss, non-healing wound are the common complications after achillestendon repair. The process,which results in re-rupture, appears to bemultifactorial, with degenerative achilles tendon, wound infection,intraoperative improper operation, postoperative achilles tendon tension tooinappropriate and so on. The postoperative wound dehiscence of manypatients lead to skin necrosis, and eventually developed into the achillestendon re-rupture and defection. Achilles tendon re-rupture complicating thenecrotic of skin loss has been troubled by the problem of the orthopedicsurgeon, because the local soft tissue defection is often accompanied by theexposed Achilles tendon. There are several different surgical methods for therepair of such organizations, such as cross-leg flap, local flap and freeflap.However there are some drawbacks with mostly methods, magnus injuryfor limbs, slow recovery prognos, difficult surgical operation and longeroperative time. The purpose of this retrospective study is to find the reasonsof skin necrosis, wound dehiscence and achilles tendon re-rupture for clinicalpreventive rupture and provide the basis of skin necrosis, seek out little injuryat the same incision with in pedicle flap was cut at the same time extend theachilles tendon, to solve the achilles tendon and a surgical skin defection.Method: Eleven patients with achilles tendon re-rupture complicatingskin and soft tissue defection were treatmented in our department from July2010to January2013. there were9males and2females; aged4to64years(average of38years old); the treatment time interval of surgery from5to91days(average of40.73days);in these patients5cases were on the left side,and6cases were on the right side;3cases were treated with hormonal,8caseswere fresh achilles tendon rupture; all patients had varying degrees of infection complicating achilles tendon defection, achilles tendon defect lengthwere4-8cm;9cases defected in the middle of the Achilles tendon，2casesdefected in the achilles tendon insertion; skin defective area were about3cm*4cm~6cm*7cm. All cases had directions of functional exercise.1case wasused “Z” plasty and free skin graft;7cases were used turndowngastrocnemius fascia flap and reversed sural neurovascular flap;1case wasused “Z” plasty and local transfer flap;2cases were used anchor combineturndown gastrocnemius fascia flap and reversed sural neurovascular flap.After surgery all patients were followed up and evaluabled for efficacyaccording to the American Orthopaedic Foot and Ankle Society (AOFAS).Result: Enrolled patients were followed up for3months to31months(average of16months). The follow-up result was excellent in10cases,fair in1case, the average scores of93.91points;2cases of these patients hadoccasional pain,4cases had before and after the activity moderately restricted,2cases had slightly difficult when they down the stairs,1case of thesepatients had slightly abnormal gait,3cases of these patients had good hindfoot activities mild limitation foot online; all patients lived without discomfortin daily, and both were very satisfied. The into the group of cases wererepaired Achilles tendon defection and skin defection at the same time,9patients were stage Ⅰ wound healing;1patient had a wound is not healing,was found the Achilles tendon completely lost activity, was cleared Achillestendon after the second surgery, the wound healed well. During follow-upthere were before and after the activity and moderately restricted;1patientwas arisesed the partial necrosis of reversed sural neurovascular flap, thewound healed well after the second surgery with cross-leg flap surgery;1patient was followed for3months, the recovery time is short, poor ankleactivity, assessed as general.Conclusion:1The skin conditions of the Achilles tendon breaks was generally poor, in therepair process should use of the Achilles tendon medial incision, the completeremoval of necrotic Achilles tendon, that could reduce the incidence of the Achilles tendon re-rupture and skin defects. Even if such complications, themedial incision could effectively protect the sural nerve, for further treatmentin patients with left choice.2Reversed sural neurovascular flap had the advantage that a simple operation,no damage to limbs major blood vessels, cut range large, addressing anincision repair of the Achilles tendon and skin defects at the same time, reducethe suffering of patients,and other characteristics. Currently, it is a optimalprosthetics for treatment of Achilles tendon re-rupture merger of skin defects.3Turndown gastrocnemius fascia flap treatmented of Achilles tendon defect>6cm was effective. When Achilles tendon rupture in Achilles tendon points,Anchor combine turndown gastrocnemius fascia flap should be used. It canrebuild the ending point firmly, help patients with early functional exerciseand reduce the occurrence of post-operative complications. It is the best wayto repair Achilles tendon avulsion fracture.