Negative pressure wound therapy-assisted granulation and grafting over exposed Achilles tendon in an...

Management of full-thickness burns over the Achilles tendon is a significant challenge due to poor vascularity, which limits granulation tissue formation and successful grafting. This is even more difficult in patients undergoing chemotherapy, whose wound healing is further compromised due to delayed cell division, migration, and angiogenesis.

A 44-year-old male undergoing chemotherapy for retrobulbar glioma sustained a full-thickness scald burn to the entire lower limb below the knee. Despite multiple tangential excisions and successful grafting over most areas, the Achilles tendon remained exposed and necrotic, with no granulation tissue formation. After debridement of the necrotic tendon followed by 2 longitudinal slit incisions until bleeding was noted, a negative pressure wound therapy device was applied at -125 mm Hg. Dressing changes were done every 3 days for 2 weeks until the tendon was fully covered by granulation tissue. A 10-cm x 5-cm split-thickness mesh skin graft was then applied over the Achilles region, which fully adhered within 1 week.

The combination of longitudinal slit incisions of the Achilles tendon and negative pressure wound therapy can enhance adequate granulation over an exposed Achilles tendon, offering a practical and effective alternative to flap coverage in immunocompromised patients.