Segmental Achilles Tendon Loss With Skin Defect in an Open Calcaneal Fracture Managed Without Tendon Reconstruction:...

The Achilles tendon, the strongest tendon in the body, is essential for plantar flexion and gait. Segmental tendon loss with soft-tissue defects is uncommon and difficult to manage, with most reported cases requiring complex reconstructions using tendon grafts or flaps. In contaminated or resource-limited settings, however, less invasive alternatives may still yield satisfactory outcomes.

A 35-year-old male sustained an open calcaneal fracture with complete midsubstance Achilles tendon transection following a motor vehicle accident. Due to delayed presentation, contamination risk, and resource limitations, no tendon reconstruction was performed. The patient underwent serial debridement, immobilization in plantar flexion, and four cycles of negative pressure wound therapy using an improvised system. By 22 weeks, the wound was fully healed with soft-tissue coverage, and ultrasound confirmed tendon continuity through scar-mediated bridging. Functionally, he demonstrated 25° dorsiflexion, 45° plantarflexion, negative Matles and Thompson tests, and independent ambulation with minimal discomfort.

This case demonstrates that segmental Achilles tendon defects may achieve functional recovery without formal reconstruction. Scar-mediated healing, supported by wound care and immobilization, provided continuity sufficient for ambulation and strength restoration. While technically demanding reconstructive methods remain the standard, this outcome highlights the potential of conservative management as a pragmatic alternative, particularly where infection, soft-tissue loss, or limited resources preclude surgery.

Conservative treatment of complex Achilles tendon injuries can restore both tendon integrity and function without reconstruction, underscoring its value as a viable option in carefully selected patients.