Negative Pressure Wound Therapy over the Achilles Tendon for Medically Compromised Ambulatory Patients

Abstract

Reconstruction of posterior ankle defects with Achilles tendon exposure caused by compromised medical conditions or trauma is a challenging issue. We present 2 cases which were successfully covered using negative pressure wound therapy (NPWT). In case 1, a 66-year-old man with a compromised status was referred for treatment of a diabetic ulcer on the right posterior ankle. Copious debridement resulted in Achilles tendon exposure. Eight weeks of NPWT followed by a split-thickness skin graft resulted in healing of the defect. In case 2, a 79-year-old male presented with a thermal burn from contact with a motorcycle muffler. Repetitive debridement exposed the Achilles tendon. Successful granulation tissue coverage was observed after 8 weeks of NPWT. There are many surgical methods to cover the exposed Achilles tendon including a local flap, free flap, or cross-leg flap, but these methods require some period of bed rest, which increases the risk of deep vein thrombosis, bedsores, and pneumonia. Bed rest also increases bone resorption and decreases bone formation, inducing osteoporosis and renal stones. However, healing by secondary intention using NPWT does not require any ambulation limitation and may be an effective reconstructive method in cardiovascularly compromised and elderly patients.