Infected Achilles Tendon Research Articles

Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Long Term Result of Four Cases without a Staged Reconstruction of an Infected Achilles Tendon Following Repair

Long Term Result of Four Cases without a Staged Reconstruction of an Infected Achilles Tendon Following Repair

What Is the Treatment "Algorithm" for Infection After Achilles Tendon Repair/Reconstruction?

The initial treatment of an infected Achilles tendon reconstruction should include thorough debridement of all infected tissues with the removal of retained sutures or foreign material. Cultures should be taken at the time of debridement, and antibiotic administration should be dictated by the result of culture and continued until inflammatory markers and clinical symptoms normalize. If significant soft tissue defect in the overlying area remains, the choice of tendon reconstruction and/or transfer with soft tissue coverage should be left up to the discretion of the treating surgeon based on preference and expertise. Revision reconstruction should be delayed until the infection is cleared. Moderate. Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

Outcomes Following Treatment of the Infected Achilles Tendon.

Background:Infection following Achilles tendon surgery is a devastating complication and can be difficult to treat and often leads to poor outcomes. A number of treatments have been described, but there is little information concerning outcomes of these treatments. Our purpose was to evaluate the clinical and functional outcomes of patients who have undergone treatment for an infected Achilles tendon after acute and chronic midsubstance repair.Methods:We retrospectively reviewed the medical records of 20 patients who had undergone surgical treatment for an infected Achilles tendon between 2000 and 2016. The mean follow-up time was 21 months (range, 2-68 months). All patients underwent extensive debridement of the tendon with removal of all infected tissue and foreign material. Soft tissue wound coverage was utilized for large wounds that were not amenable to primary or secondary closure. All patients received culture-specific intravenous (IV) antibiotics for 3 to 6 weeks. Postoperatively, the extremity was immobilized in a splint followed by a cast until the wound was healed. The cast was then replaced with a walking boot and the patients were provided a physical therapy program. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) Activity of Daily Living (ADL) scale.Results:All wounds had healed at the time of last follow-up. Three patients (15%) required an unplanned return to the operating room for repeat debridement. All patients were able to walk without the use of a gait aid. Five patients (25%) required continued use of a boot or brace during ambulation. Fourteen patients participated in the FAAM ADL survey. There were 6 patients lost to follow-up. The average FAAM score was 87 (range, 71.4-100). At last follow-up, most patients reported their overall function as “normal” or “nearly normal.” Eradication of infection and satisfactory functional results can be attained after radical debridement, wound closure, and administration of culture-specific IV antibiotics.Level of Evidence:Level IV, retrospective case series.

Outcomes following treatment of the infected Achilles tendon

Category: Sports Introduction/Purpose: Infection following Achilles tendon surgery is a devastating complication and can be difficult to treat. Our purpose was to evaluate clinical and functional outcomes of patients who have undergone treatment for an infected Achilles tendon. Methods: We retrospectively reviewed the medical records of 20 patients who had undergone surgical treatment for an infected Achilles tendon between 2000 and 2016. The mean follow-up time was 21 months (range 2-68 months). All patients underwent extensive debridement of the tendon with removal of all infected tissue and foreign material. Soft tissue wound coverage was utilized for large wounds that were not amenable to primary or secondary closure. All patients received culture specific intravenous antibiotics for three to six weeks. Postoperatively, the extremity was immobilized in a splint followed by a cast until the wound was healed. The cast was then replaced with a walking boot and the patients were provided a physical therapy program. Functional outcomes were measured using the Foot and Ankle Ability Measure (FAAM) Activity of Daily Living (ADL) scale. Results: All wounds had healed at the time of last follow-up. Three patients (15%) required an unplanned return to the operating room for repeat debridement. All patients were able to walk without the use of a gait aid. Five patients (25%) required continued use of a boot or brace during ambulation. The average FAAM score was 87 (range, 71.4-100). At last follow-up, most patients reported their overall function as “normal” or “nearly normal”. Conclusion: Eradication of infection and satisfactory functional results can be attained after radical debridement, wound closure, and administration of culture specific IV antibiotics.

Composite Flexor Hallucis Longus and Free Gracillis Flap for Infected Achilles Tendon

ABSTRACT Primary infection of tendo-achilles (TA) is quite uncommon. Here, we are presenting an interesting case of a 42-year-old farmer who developed TA infection following thorn prick injury (3-month-old injury). He presented to us with discharging sinus on posterior aspect of heel. On subsequent debridement, he had 17 cm tendon defect, which was treated with flexor hallucis longus (FHL) tendon and reinforced with free gracillis flap from opposite thigh. However, to the best of our knowledge, combined use of FHL and gracillis tendon has so far not reported. How to cite this article Simon R, Gadgil A, Jose DP. Composite Flexor Hallucis Longus and Free Gracillis Flap for Infected Achilles Tendon. J Foot Ankle Surg (Asia-Pacific) 2017;4(2):100-102.

Tendon Resection and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair

Category: Other. Introduction/Purpose: An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon, itself, as well as the thin surrounding soft tissue. For management of an infected Achilles tendon following tendon repair, we first focused on complete debridement with tenectomy and then promoted scar healing of the Achilles tendon using functional management. Methods: We retrospectively reviewed all of the medical records of 15 patients with post-operative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, twenty two to 97 months). Tenectomy with radical debridement was performed, and the ankle was placed in a short leg splint for two weeks. The splint was then replaced with an ankle brace for the next four weeks. Partial weight-bearing walking was allowed immediately, and full weight-bearing walking was allowed two weeks postoperatively. We assessed the physical parameters such as range of motion, the calf circumference, capability of single heel raising, satisfactions and the Arner Lindholm scale were recorded. Laboratory test, post- operative ultrasonography and isokinetic plantar flexion power was also checked. Results: At the final follow-up, any sign of infection had disappeared without recurrence in all of the patients. Achilles tendon continuity recovered in all by scar healing. Compared to the contralateral side, there was no difference in the range of motion in eight patients. According to the Arner Lindholm scale, nine of fifteen cases were excellent and the other six cases were good. Their ability regarding single-heel rising on involved leg was achieved in ten patients. Eleven of 15 patients could return to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity within the tendon sheath was observed on the ultrasonographic examination or MRI. Conclusion: Tenectomy of infected Achilles tendon and radical debridement with vigorous rehabilitation is simple and successful management way for the postoperative infection following Achilles tendon repair.

Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair.

An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon as well as the thin surrounding soft tissue. For treatment of an infected Achilles tendon following tendon repair, we first focused on complete debridement and then promoted fibrous scar healing of the Achilles tendon using functional treatment. We retrospectively reviewed all of the medical records of 15 tertiary referral patients with postoperative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, 22 to 97 months). The infected tissue and the necrotic tendon were debrided, and the ankle was placed in a short leg splint for 2 weeks. The splint was then replaced with an ankle brace for the next 4 weeks. Partial weight-bearing was allowed immediately, and full weight-bearing was allowed at 2 weeks postoperatively. We assessed and recorded the physical parameters such as the range of motion, calf circumference, ability to perform a single-limb heel rise, patient satisfaction, and Arner-Lindholm scale. Laboratory tests, postoperative ultrasonography, and isokinetic plantar flexion power tests were also performed. At a mean time of 17 days (range, 8 to 30 days) after debridement, infection signs such as discharge from the wound, redness, and local warmth resolved. The wound had healed and the stitches were removed at a mean of 17 days following the wound repair. At the time of the latest follow-up, there were no signs of active infection. Achilles tendon continuity recovered in all patients by fibrous scar healing. Compared with the contralateral side, there was no difference in the ankle range of motion in 8 patients. According to the Arner-Lindholm scale, 9 of the 15 results were excellent and 6 were good. Ten patients were able to perform a single-limb heel rise. Eleven of 15 patients returned to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity was observed on the ultrasonographic examination. In this retrospective series, radical debridement, combined with antibiotic therapy and functional rehabilitation, was successful in eradicating infection and maintaining function in patients with postoperative infection following Achilles tendon repair. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Vakuumtherapie bei tiefem Wundinfekt nach Achillessehnenrekonstruktion

Vacuum therapy is a valuable option for wound healing complications. After reconstruction of the ruptured achilles tendon, deep wound infections are difficult to handle due to impaired circulation of the bradytrophic tissue which leads to infection and a protracted healing process. Consecutive necrosis of the achilles tendon results in a poor clinical outcome. We could prove that vacuum therapy is the method of choice for wound healing complications in this delicate area. We treated 5 patients with deep wound infection and exposed achilles tendon after reconstruction. In all cases we achieved complete closure. The function of the achilles tendon was not impaired. Sonography confirmed the integrity of the tendon in all cases. Duration of therapy was 8.4 days for inpatient treatment and 64.4 days overall. 3 patients received a mesh-graft transplantation after wound ground preconditioning with vacuum therapy, all others achieved complete restoration with vacuum only. Vacuum therapy is a valuable option for the treatment of infected achilles tendon after surgical repair. After wound ground conditioning, it can protect mesh-graft transplants in this delicate area even in non-compliant patients.

Open infected Achilles tendon injury—Reconstruction of tendon with fascia lata graft and soft tissue cover with a reverse flow sural flap

We present a patient with an open, infected Achilles tendon injury with a soft tissue defect of 12 cm x 5 cm and a tendon defect of 10 cm. He underwent a two-stage procedure. A first stage debridement of tendon and soft tissue was followed by a second stage tendo Achilles reconstruction using fascia lata graft and soft tissue cover with a reverse flow sural flap. He had a good functional outcome with minimal donor site morbidity.

Ankle Arthrodesis Using Ilizarov Ring Fixators: A Review of 22 Cases

Orthopaedic surgeons are being increasingly confronted with complex ankle problems that cannot be reliably treated by conventional arthrodesis procedures. The Ilizarov technique can be an alternative salvage method in such cases. Twenty-two Ilizarov tibiotalar arthrodeses were retrospectively reviewed. There were 16 men and six women (mean age 49 years). The underlying pathology was infection after internal fixation of ankle or plafond fractures in 16 patients, posttraumatic ankle arthritis in five, and septic arthritis after an infected Achilles tendon repair in one. Five patients had at least one failed previous arthrodesis. Primary iliac crest bone grafting was done in two patients. Proximal tibial lengthening was done in six patients. Twenty-one patients were followed for an average of 29 months. A solid fusion was achieved in all patients by the end of treatment. The external fixation time averaged 27.7 (range 12 to 84) weeks. The mean time spent in a foot frame was 22.3 weeks. Complications occurred in 11 patients, including two nonunions that healed after revision and renewed frame application and four pin track infections. The use of the Ilizarov frame provides a successful salvage method that offers solid bony fusion, optimal leg length, and eradication of infection in complex ankle pathology or failed previous arthrodesis.

Management of Chronic Achilles Tendon Infection with Musculotendinous Gracius Interposition Free-Flap Coverage

Management of infected Achilles tendon repair poses a significant reconstructive problem. Thorough debridement is most important and resection of non-viable tendon substance is required. Reconstruction of such tendon defects requires vascularized soft-tissue coverage that is stable and that offers the possibility of functional restoration. Gracilis free-tissue transfer is an effective means of providing stable, durable, well-vascularized, soft-tissue coverage in an infected Achilles tendon repair. The microsurgical anastomoses are technically straightforward. Cybex II dynomometer measurements, performed 6 months following free-tissue transplantation, revealed strength (torque) and power, at an angular velocity of 45 degrees per second, of: 59 percent and 52 percent, respectively, compared to the uninjured side. Endurance was assessed at an angular velocity of 120 degrees per second over a 15-second test interval, and was noted to be 81 percent, compared to the normal ankle. Excellent functional results and acceptable soft-tissue contour can be expected with this technique.