Open Achilles Tendon Defects: A 12-year Study on the Injury Mechanisms, Reconstructions, and Late Complications

Zhu, Yaofeng; Xu, Yongqing; Mei, Liangbin; Wang, Yi; Li, Fubing; Sun, Linhui

doi:10.1055/s-0033-1358787

Cited by 7 publications

(8 citation statements)

References 28 publications

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“…Most of the injuries were right-sided, similar to previous findings. 1,21,22 Curiously, the soft tissue defects in 25 cases in this group were mainly at the lateral aspect of the heel, whereas the defects of only 6 cases were at the medial aspect of the heel, suggesting that the mechanism of motorcycle spoke injury is more complicated than previously suspected. A possible mechanism is that when the FIGURE 2.…”

Section: Discussionmentioning

confidence: 65%

Post Traumatic Reconstruction of the Pediatric Heel and Achilles Tendon

Zhu

Duan³

et al. 2016

Annals of Plastic Surgery

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Severe motorcycle spoke injuries of the heel lead to Achilles tendon defects, calcaneal tubercle exposure or loss, and overlying soft tissue defects, which are challenging to treat. Given the special physiological and developmental characteristics of children, severe spoke injuries of the heel in children are especially troublesome.We report details of 31 cases of severe motorcycle spoke injuries of the heel in children. The reconstruction timing depended on the time since injury, systematic conditions, and concurrent injuries. Eighteen cases were reconstructed at the time of emergency surgery, and 13 cases underwent delayed reconstruction. Appropriate flap transfer and Achilles tendon repair were conducted based on the defect size of the Achilles tendon, the main location of the soft tissue defect, and the distal residues of the Achilles tendon.Of the 31 cases, 16 cases were reconstructed with sliding gastrocnemius musculocutaneous flaps, 7 cases had saphenous neurocutaneous flaps, 4 cases had posterior tibial perforator flaps, 3 cases had sural neurocutaneous flaps, and 1 case was repaired with a peroneal artery perforator flap. All flaps healed uneventfully except for 3 cases of flap partial necrosis and 1 case of local infection of the Achilles tendon. During 6 months to 4 years of follow-up, dorsiflexion of the ankle was obviously limited at first but gradually recovered and enabled normal walking. However, due to the possibilities of calcaneal defects, epiphyseal injuries, and Achilles tendon problems, long-term follow-up is indicated.

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Section: Discussionmentioning

confidence: 65%

Post Traumatic Reconstruction of the Pediatric Heel and Achilles Tendon

Zhu

Duan³

et al. 2016

Annals of Plastic Surgery

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“…Several factors should be carefully evaluated to ensure successful outcomes of reconstruction; these include age of the patient, exposed vital structures, size of the defect, comorbid diseases, presence of scars, history of previous surgery, infection, medications, smoking, and patient expectations. 1,2 During reconstruction in this region, neurovascular bundle repair and tendon-skin-soft tissue reconstruction can be performed together or sequentally, as per need. In the presence of a ruptured, necrotic or weakened tendon, reconstruction should be performed concomitantly with soft tissue-skin repair.…”

Section: Discussionmentioning

confidence: 99%

“…Reconstruction of defects of Achilles tendon and overlying tissues is a challenging undertaking 1,2 . These defects are typically caused by trauma, infection, or excision of tumors 3 .…”

Section: Introductionmentioning

confidence: 99%

Reconstruction of Achilles region defects: a single-center experience

Eser¹,

Ceylan²,

Gencel³

et al. 2021

Preprint

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Background: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to use of free flaps. Method: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single center. Results: Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6), and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Conclusion: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. Use of special digital imaging techniques facilitates flap surgery and helps minimize the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Superthin free flaps offer a distinct advantage in skillful hands. Use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favorable outcomes.

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“…Im Gegensatz zu randomisierten lokalen Lappenplastiken werden gestielte Lappenplastiken, wie der Suralislappen 21 oder der Pe- roneus brevis-Lappen 22 23 , abhängig vom therapeutischen Ar- mamentarium der jeweiligen Klinik, regelhaft angewandt. Aller- dings haben diese Lappenplastiken eine hohe Komplikationsrate.…”

Section: Ergebnisseunclassified

Rekonstruktionen von Weichteildefekten der Achillessehnen region – eine Literaturübersicht

Rein

Kremer

2022

Handchir Mikrochir Plast Chir

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Zusammenfassung Hintergrund Weichteildefekte der Regio tendinis achilleae treten nach Traumata und insbesondere als Komplikation nach offener Rekonstruktion der Sehne mit nachfolgendem Infekt auf. Ziel der Arbeit Es werden Empfehlungen zur Therapie von Weichteilverletzungen mit Beteiligung der Achillessehne im Kontext der Literatur formuliert. Material und Methoden Es wurde eine Recherche der deutsch-, französisch- und englischsprachigen Literatur zur Rekonstruktion von Hautweichteildefekten der Achillessehnenregion durchgeführt, welche in singuläre und kombinierte tendokutane Defekte differenziert wurden. Kombinierte Defekte wurden basierend auf drei rekonstruktiven Prinzipien weiter untergliedert in: ein alleiniger Verschluss der Haut ohne Sehnenrekonstruktion sowie eine Rekonstruktion der Haut zusammen mit einer Sehnenrekonstruktion als vaskularisiertes oder avaskuläres Transplantat. Ergebnisse Lokale und distal gestielte Lappenplastiken sind für die Rekonstruktion über der Achillessehne mit einer hohen lokalen Morbidität behaftet, weshalb die Autoren freie Lappenplastiken aufgrund der geringeren Komplikationsrate favorisieren. Hier eignet sich für kleine Defekte die freie Medial Sural Artery (MSAP-)Lappenplastik, bei großen Defekten Muskeloder fasziokutane Lappenplastiken. Technik der Wahl für die kombinierte tendokutane Rekonstruktion ist die ALTLappenplastik mit vaskularisierter Fascia lata. Als nicht vaskuläre Sehnentransplantate werden häufig die Sehne des M. flexor hallucis longus oder des M. peroneus brevis verwendet. Fazit Die Rekonstruktion der Achillessehnenregion erfordert dünne strapazier- und gleitfähige Lappen, die eine Schuhver- sorgung ermöglichen. Die postoperative Kraft und Beweglichkeit des Sprunggelenkes zeigen vergleichbare funktionelle Resultate nach vaskularisierter und nicht vaskularisierter Seh- nenrekonstruktion.

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Open Achilles Tendon Defects: A 12-year Study on the Injury Mechanisms, Reconstructions, and Late Complications

Abstract: Open Achilles tendon defects are characteristic of concurrent skin and bone injuries and the reconstruction protocols of the different tissues should not be separated.

Cited by 7 publications

References 28 publications

Post Traumatic Reconstruction of the Pediatric Heel and Achilles Tendon

Post Traumatic Reconstruction of the Pediatric Heel and Achilles Tendon

Reconstruction of Achilles region defects: a single-center experience

Rekonstruktionen von Weichteildefekten der Achillessehnen region – eine Literaturübersicht

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