Clinical Comparison Of Reverse Fascial Flap Arc Incision And Traditional Incision For Closed Achilles Tendon Rupture

Objective: The treatment of acute closed Achilles tendon rupture can be divided into conservative treatment and surgical treatment.The surgical treatment of acute Achilles tendon rupture can be divided into traditional incision suture,percutaneous small incision and minimally invasive suture.Now,mainly for Achilles tendon rupture after traditional incision of local tissue adhesions,margin and necrosis of the skin incision is the Achilles tendon exposure etc.The reverse fascial flap related complications,incision and traditional incision to compare the curative effect of the treatment of acute closed rupture of the Achilles tendon.Methods: Patients were include in the citeria: From January 2015 to December 2016,injured during exercise in patients with acute closed rupture of Achilles tendon were treated in our hospital.The patients who were injured acute closed Achilles tendon rupture caused by exercise,who were admitted to our hospital.The age range of 18-65 years old.The cases excluded criteria: Achilles tendon rupture history,past history of Achilles tendinitis,previous local trauma history,local or systemic skin condition the limb activity with ineffective and sensory disorders,long-term quinolones and local hormone history with mental disorders cannot match.This study included a total of 39 patients with closed Achilles tendon rupture.Divided into experimental group and control group.The experimental group(group A)by reverse fascial flap incision: the range of Group A ages is from 22-62 years old,mean age 40.2 ± 8.56 years,there were 10 males and 1 females,7 cases on the left side,right side in 4 cases.The control group(B group)with traditional medial longitudinal incision: the range of Group B ages is from 22-53 years old,mean age 34.0 ± 5.43 years,there were 25 males and 3 females,13 cases on the left side,right side in 15 cases.The patients were followed up for 3 months-22 months.Two groups of patients were given the same postoperative plaster fixation and rehabilitation of the same functional exercise.The healing of incision was observed(healing time,incisional margin necrosis,infection of incisional and Achilles tendon exposure),sural nerves have paresthesias,and to evaluate the effect of Arner-Lindholm and AOFAS using the standard for evaluation of ankle function score.Statistical analysis used SPSS 22.0 statistical software in this study.Results: Reverse fascial flap arc incision(group A),Patients were followed up for 4-19 months.traditional incision(group B),Patients were followed up for 3-22 months.The incision healed in group A,The healing time was 12.36 ± 0.60 days,and there was no incision related complications(edge necrosis,infection,Achilles tendon exposure)occurred and there was no abnormal skin sensation in the sural nerve innervation area.Arner-Lindholm was evaluated after 12 weeks of operation: Excellent: 10 cases,accounting for 91%,Good: 1 cases,accounting for 9%,Poor: 0 cases,accounting for 0%.AOFAS evaluation of ankle function score: Excellent: 11 cases,accounting for 100%.Good: 0 cases,accounting for 0%.General: 0 cases,accounting for 0%.Poor: 0 cases,accounting for 0%.The average scores was 95.27 ± 1.39.The incision healed in group B,The healing time was 13.68 ± 2.45 days.There were 4 cases of edge necrosis,the number of incision infection cases was 1.There was no Achilles tendon exposure and no abnormal skin sensation in the sural nerve innervation area.Arner-Lindholm was evaluated after 12 weeks of operation: Excellent: 24 cases,accounting for 86%,Good: 3 cases,accounting for 11%,Poor: 1 cases,accounting for 3%.AOFAS evaluation of ankle function score: Excellent: 24 cases,accounting for 86%.Good: 2 cases,accounting for 7%.General: 2 cases,accounting for 7%.Poor: 0 cases,accounting for 0%.The average scores was 92.93 ± 4.84.Conclusion: The reverse fascial flap arc incision has changed the traditional incision parallel longitudinal with the Achilles tendon.Prevent scar contracture of the ankle flexion and extension,intraoperative repair of tendon fascial tissues to mechanical sliding tendon increased,while the deep fascia incision and incision of skin covering each other further to avoid the risk of Achilles tendon exposure the cutting edge necrosis.In order to reduce the local tissue adhesions,lower edge necrosis and Achilles tendon exposure risk.