Reconstruction of skin and tendon defects from wound complications after Achilles tendon rupture

Four patients who developed combined tendon and overlying skin defects following operative repair of ruptured Achilles tendon were presented. Three patients had an infected wound. The average interval from the first operation for repairing the ruptured Achilles tendon and the reconstructive procedure was 46.2 days (range, 5-65 days). All patients were treated with a one-stage operation including radical debridement, reconstruction of the Achilles tendon defects using vascularized or nonvascularized tendon grafts, transfer of peroneus brevis for augmentation, and skin coverage with a free flap. The patients recovered uneventfully. The average follow-up period was 39.2 months (range, 18-79 months). In all patients, an evaluation of the clinical outcome, the performance of the calf muscles using a computerized dynamometer, and structural changes of the reconstructed Achilles tendon using magnetic resonance (MR) imaging were made. The clinical outcome was excellent in three patients and good in one. In isokinetic testing (Cybex-Norm), strength was found to be normal in one patient and abnormal in three patients. MR images revealed an intratendinous area of homogenous and normal intensity signal, and a significant increase in thickness and width in all levels of the reconstructed Achilles tendon. The authors conclude that it is possible to obtain satisfactory function in patients with complex wounds in the region of the Achilles tendon.