[Management of soft tissue defect after achilles tendon repair].

OBJECTIVE

To investigate the management of the soft tissue defect after the Achilles tendon repair.

METHODS

From April 1996 to April 2006, 24 patients (17 males, 7 females; aged 16-59 years), who suffered from postoperative Achilles tendon exposure caused by local soft-tissue necrosis after the Achilles tendon repair, were treated and evaluated. Of the 24 patients, 8 had an original open injury (machine-crush injury in 2 patients, heavy-object press injury in 3, motor-cycle wheel crush injury in 3) and 16 patients had a closed injury (sports injury). In their treatment, the transfer of the sural neurovascular flap was performed on 8 patients and the transfer of the saphenous neurovascular flap was performed on 3 patients. The secondary Achilles tendon repair was performed on 13 patients before the neurovascular flap transfer was performed. The time between the injury and the operation was 9-76 days, and the time between the Achilles tendon expousure and the operation was 3-65 days.

RESULTS

All the flaps survived and the Achilles tendon exposure was well covered by the flaps of good texture. Eighteen patients followed up for 6 months to 24 months had no flap complication, and the two point discrimination of the flaps was 12-20 mm. The AOFAS Ankle-Hindfoot Scale assessment revealed that 8 patients had an excellent result, 6 had a good result, 3 had a fair result, and just 1 had a poor result, with the excellent and good results accounting for 77.8%. Sixteen patients (89%) were able to perform a tip-toe stance on their operative sides, and only 3 of them complained a loss of plantarflexion strength. However, 2 patients still could not perform the tip-toe stance.

CONCLUSION

The Achilles tendon repair, if not well performed, can result in the local soft-tissue necrosis and the subsequent Achilles tendon exposure. If those complications occur, the neurovascular flap transfer should be performed as soon as possible; if necessary, the secondary Achilles tendon repair should be performed, too.