Treatment of Extensive Aseptic Defects in Old Achilles Tendon Ruptures: Methods and Case Reports

Abstract

Defect bridging is still problematic in the secondary treatment of Achilles tendon ruptures. Smaller defects can be treated without problems by the well-known standardized methods, whereas other methods have to be applied for treating larger defects. Free transplants with autogenous or exogenous material should be mentioned in this context. Complications are more likely to occur with exogenous material, free transplants from the fascia lata require an additional intervention to remove the transplant from another localization. These methods cannot be applied to achieve reliable restoration of continuity for defects with a length of 10 cm. Therefore, in these special cases, we carry out the tendon transplantation with a free tendon-muscle graft from the triceps surae muscle. We achieved reliable restoration of continuity with complication-free healing of the free transplant in, up to now, three cases, in association with the formation of a strong, functionally high grade scar plate in the area of the tendon.

Tendon Transfers for Achilles Reconstruction

“…When the deficiency is small, direct repair can be attempted; however, in most situations, the chronicity of the rupture results in a significant segment of tendon that requires excision, leaving a moderate gap that prevents primary apposition. In these cases, local tendinous flaps, [19][20][21] advancements, [22][23][24] autograft tissue, 25,26 or allograft tissue 27,28 can be used to restore continuity of the muscle tendinous unit. When these gaps are large or muscle degeneration has occurred within the gastrocnemius and soleus muscle, tendon transfers can provide a viable option for reconstruction.…”

V-Y advancement flap for repair of neglected injuries of the Achilles tendon using 2 mini-incisions

“…Other studies, such as that of Kissel et al (7) , coincide in the distance of defects (above 5cm) to be fixed using this technique. A study by Leimer et al increased the length of fixable defects to up to 10cm (8) . All referenced authors used a surgical approach consisting of a single extensive incision.…”

Endoscopic Transfer of Flexor Hallucis Longus Tendon for Chronic Achilles Tendon Rupture: Technical Aspects and Short-Time Experiences

“…[17][18][19] There are, however, some reports on closing 8-to 10-cm defects with this method. 20 Other Achilles tendon fascial turn-down plastics, for example, the Lindholm plastic, are methods that are described to be able to handle tendon gaps of 5 to 9 cm. 21,22 Larger gaps could also be handled by free tendon graft transfer.…”