Background: There is no consensus on the best method for management of acute Achilles tendon ruptures. Individual preferences, drawn from experience and study, determine whether treatment is operative or nonoperative.Purpose: Our goal was to review the literature to try to determine what management method was the most popular and effective. We wanted to ascertain the best results in terms of complication rates and patient outcomes.Study Design: Retrospective review of retrospectively and prospectively collected data.Methods: We analyzed 125 articles in peer-reviewed journals for year of publication, patient numbers, sex, management method, follow-up complications, and patient satisfaction. Each article was graded using a validated methods score. Methods, patient satisfaction, and complication rates were correlated with the year each article was published.Results: Skin-healing complications were lowest in conservatively managed patients (3 of 578, 0.5%) and highest in open repair and immobilized patients (...

Quantitative Review of Operative and Nonoperative Management of Achilles Tendon Ruptures

Ten knees in nine patients underwent gradual soft tissue expansion prior to major knee surgery. All patients had multiple prior operative procedures around the knee. The resultant multiple skin incisions were felt to potentially jeopardize the postoperative status of the soft tissues. Each knee underwent the surgical placement of a tissue expander through a bed of adjacent healthy soft tissue followed by the gradual inflation of the expander over an average of 64.5 days. The average volume of soft tissue expansion was 313.7 mL per knee. Subsequent major knee surgery requiring an arthrotomy was performed at the time of expander removal followed by uncomplicated soft tissue closure. All wounds healed without any complications.

Soft tissue expansion prior to arthroplasty in the multiply-operated knee : a new method of preventing catastrophic skin problems

A 36-year-old male sustained loss of the Achilles mechanism secondary to a crush injury. The patient was treated with early placement of a cement spacer in the superficial posterior compartment, which allowed for successful late reconstruction.

Complex Achilles reconstruction for massive soft tissue loss: allograft, autograft, and use of a temporary cement spacer.

We report on two patients with severely complicated Achilles tendon ruptures (ATR), including re-rupture, postoperative deep infection and subsequent tissue loss Tissue expansion was used to facilitate tendon reconstruction and to ensure good healing potential with skin closure without tension Tissue expansion is a valid option in patients with complicated ATR The outcome for the two patients described here was good, with improved function and no major complications

Tissue expansion for repair of severely complicated Achilles tendon ruptures.

Objectives: Augmented repair techniques are used in defective Achilles tendon ruptures and provide excellent functional results in active individuals, but it carries an incidence of wound complications like tendon adhesion to the skin. Tendon adhesion is an important minor complication. We present an augmentation technique for Achilles tendon rupture that we believe prevents tendon adhesion to the skin. Material and methods: Four male patients with a mean age of 38 (29 to 56) were diagnosed as having a ruptured Achilles tendon. Duration of ruptures was 1, 2, 35 and 45 days. We used a new flap technique in these patients with defective acute and chronic Achilles tendon ruptures. A strip of aponeurotic flap, 8 cm long and 2cm wide, was elevated proximally from the median raphe of gastrocnemius, and twisted 180 degrees on itself from medial sides, so its smooth external surface lies next to the skin and covers the rupture site, and the plantaris tendon was incorporated in the repair site. Results: The mean follow-up period was 42 months (23 to 60). There were no reruptures. One had skin necrosis and healed satisfactorily with debridement and secondary sutures. None of them had tendon adhesion to the skin. Satisfactory overall results and very good functioning was achieved in four patients. Conclusion: If augmented repair of Achilles tendon rupture is preferred, this technique can be used satisfactorily and tendon adhesion to the skin is

/pdf/augmented-repair-of-achilles-tendon-ruptures-2p3tuq6zd7.pdf

Augmented Repair of Achilles Tendon Ruptures

We report four patients with late presentation of rupture of tendo Achillis, treated by soft-tissue expansion of the skin before tendon repair to allow tension-free wound closure

Tissue expansion in late repair of tendo Achillis rupture

Laparoscopic Heller Cardiomyotomy with Dor Fundoplication versus Nissen Fundoplication in the Management of Type II Achalasia: A Prospective Randomized Study

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Tissue expansion in late repair of tendo Achillis rupture

Laparoscopic Heller Cardiomyotomy with Dor Fundoplication versus Nissen Fundoplication in the Management of Type II Achalasia: A Prospective Randomized Study