A New Surgical Approach for Reconstruction of the Achilles Tendon

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Abstract

Background. The limited skin mobility on the posterior surface of the lower third of the leg, along with a small amount of subcutaneous fat and the close proximity of the Achilles tendon, predisposes this area to tissue defects following surgery. Numerous surgical approaches have been proposed; however, none of them completely address the problem of tissue defect elimination when correcting persistent equinus foot deformity.

The aim of the study — to demonstrate a new surgical approach for Achilles tendon reconstruction.

Surgical technique description. The surgical approach for Achilles tendon lengthening involved creating an arched incision and sequentially isolating the skin and fascial flaps. Achilles tendon shortening was corrected using Z-plasty. After that, the tendon was covered first with a fascial flap, and then the skin was partially sutured without tension. The remaining soft tissue defect was covered with a skin graft. Patients underwent 6 weeks of plaster immobilization, after which full weight-bearing on the operated leg and physical therapy was allowed.

Conclusion. The described surgical approach is simple to perform and allows for the simultaneous replacement of tissue defects following the correction of equinus foot deformity.

About the authors

Evgeny S. Tsybul

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: na4med@inbox.ru
ORCID iD: 0009-0001-8105-3635

Cand. Sci. (Med.)

Russian Federation, St. Petersburg

Lubov A. Rodomanova

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: rodomanovaliubov@yandex.ru
ORCID iD: 0000-0003-2402-7307

Dr. Sci. (Med.), Professor

Russian Federation, St. Petersburg

Vladislav I. Malyshev

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: trauma@malyshevdoc.ru
ORCID iD: 0009-0003-4609-7506
Russian Federation, St. Petersburg

References

  1. Hackenberg R.K., Täger S., Prangenberg C., Kabir K., Welle K. Reconstruction of Complicated Achilles Tendon Ruptures with Soft Tissue Defects – a Systematic Overview and Development of a Treatment Algorithm. Z Orthop Unfall. 2021;159(3):314-322. (In English, German). https://doi.org/10.1055/a-1073-8516.
  2. Ho G., Tantigate D., Kirschenbaum J., Greisberg J.K., Vosseller J.T. Increasing age in Achilles rupture patients over time. Injury. 2017;48(7):1701-1709. https://doi.org/10.1016/j.injury.2017.04.007.
  3. Egger A.C., Berkowitz M.J. Achilles tendon injuries. Curr Rev Musculoskelet Med. 2017;10(1):72-80. https://doi.org/10.1007/s12178-017-9386-7.
  4. Gross C.E., Nunley J.A. 2nd. Acute Achilles Tendon Ruptures. Foot Ankle Int. 2016;37(2):233-239. https://doi.org/10.1177/1071100715619606.
  5. Cottom J.M., Sisovsky C.A. Neglected Achilles Tendon Ruptures. Clin Podiatr Med Surg. 2021;38(2):261-277. https://doi.org/10.1016/j.cpm.2020.12.010.
  6. Buddecke D. Jr. Acute Achilles Tendon Ruptures. Clin Podiatr Med Surg. 2021;38(2):201-226. https://doi.org/10.1016/j.cpm.2020.12.006.
  7. Середа А.П. Застарелые разрывы ахиллова сухожилия – как их лечить и возможно ли спонтанное сращение? Результаты укорачивающей тенопластики. Травматология и ортопедия России. 2018;(2):59-69. https://doi.org/10.21823/2311-2905-2018-24-2-59-69. Sereda A.P. Treatment Options for Neglected Achilles Tendon Ruptured: Wether Spontaneous Healing is Possible? Traumatology and Orthopedics of Russia. 2018;24(2):59-69. (In Russian). https://doi.org/10.21823/2311-2905-2018-24-2-59-69.
  8. Liles J., Adams S.B. Jr. Management of Complications of Achilles Tendon Surgery. Foot Ankle Clin. 2019;24(3): 447-457. https://doi.org/10.1016/j.fcl.2019.04.008.
  9. McQuilling J.P., Sanders M., Poland L., Sanders M., Basadonna G., Waldrop N.E. et al. Dehydrated Amnion/Chorion Improves Achilles Tendon Repair in a Diabetic Animal Model. Wounds. 2019;31(1):19-25.
  10. Rensing N., Waterman B.R., Frank R.M., Heida K.A., Orr J.D. Low Risk for Local and Systemic Complications After Primary Repair of 1626 Achilles Tendon Ruptures. Foot Ankle Spec. 2017;10(3):216-226. https://doi.org/10.1177/1938640016676340.
  11. Lim J., Dalal R., Waseem M. Percutaneous vs. open repair of the ruptured Achilles tendon – a prospective randomized controlled study. Foot Ankle Int. 2001;22(7): 559-568. https://doi.org/10.1177/107110070102200705.
  12. Lin C.T., Chen S.G., Chen T.M., Dai N.T., Chang S.C. Bipedicled flap for the reconstruction of soft tissue defects of the Achilles tendon. Ann Plast Surg. 2015;74(4):484-487. https:// doi.org/10.1097/SAP.0b013e3182a1e508.
  13. Marchesi A., Parodi P.C., Brioschi M., Riccio M., Perrotta R.E., Colombo M. et al. Soft-tissue defects of the Achilles tendon region: Management and reconstructive ladder. Review of the literature. Injury. 2016;47 Suppl 4:S147-S153. https:// doi.org/10.1016/j.injury.2016.07.053.
  14. Abraham E., Pankovich A.M. Neglected rupture of the Achilles tendon. Treatment by V-Y tendinous flap. J Bone Joint Surg Am. 1975;57(2):253-255.
  15. Winnicki K., Ochała-Kłos A., Rutowicz B., Pękala P.A., Tomaszewski K.A. Functional anatomy, histology and biomechanics of the human Achilles tendon – A comprehensive review. Ann Anat. 2020;229: 151461. https://doi.org/10.1016/j.aanat.2020.151461.
  16. Soroceanu A., Sidhwa F., Aarabi S., Kaufman A., Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Joint Surg Am. 2012; 94(23):2136-2143. https://doi.org/10.2106/JBJS.K.00917.
  17. Pękala P.A., Henry B.M., Ochała A., Kopacz P., Tatoń G., Młyniec A. et al. The twisted structure of the Achilles tendon unraveled: A detailed quantitative and qualitative anatomical investigation. Scand J Med Sci Sports. 2017;27(12):1705-1715. https:// doi.org/10.1111/sms.12835.
  18. Кисель Д.А., Файн А.М., Светлов К.В., Власов А.П., Лазарев М.П., Акимов Р.Н. и др. Оптимальный хирургический доступ при восстановлении ахиллова сухожилия. Вестник медицинского института «РЕАВИЗ». Реабилитация, Врач и Здоровье. 2023;13(6):125-130. https:// doi.org/10.20340/vmi-rvz.2023.6.CLIN.15. Kisel’ D.A., Fayn A.M., Svetlov K.V., Vlasov A.P., Lazarev M.P., Akimov R.N. et al. Optimal access for Achilles Tendon Repair. Bulletin of the Medical Institute «REAVIZ» (Rehabilitation, Doctor and Health). 2023;13(6):125-130. (In Russian). https://doi.org/10.20340/vmi-rvz.2023.6.CLIN.15.
  19. Зулкарнеев Р.А., Ахметов З.Я. Повреждения ахиллова сухожилия и результаты оперативного лечения. Казанский медицинский журнал. 1989;70(6):429-431. Zulkarneev R.A., Akhmetov Z.Y. Achilles tendon injuries and results of surgical treatment. Kazan Medical Journal. 1989;70(6):429-431. (In Russian).
  20. Миронова З.С., Черкасова Т.И., Башкиров В.Ф. Подкожные разрывы ахиллова сухожилия. Ташкент: Медицина; 1974. 114 с. Mironova Z.S., Cherkasova T.I., Bashkirov V.F. Subcutaneous ruptures of Achilles tendon. Tashkent: Medicine; 1974. 114 р. (In Russian).
  21. Di Stefano V.J., Nixon J.E. Achilles tendon rupture: pathogenesis, diagnosis and treatment by a modified pullout wire technique. J Trauma. 1972;12(8):671-677.
  22. Li C.G., Li B., Yang Y.F. Management of acute Achilles tendon rupture with tendon-bundle technique. J Int Med Res. 2017;45(1):310-319. https://doi.org/10.1177/0300060516677928.
  23. Inglis A.E., Sculco T.P. Surgical repair of ruptures of the tendo Achillis. Clin Orthop Relat Res. 1981;(156):160-169.
  24. Green S.M., Briggs P.J. A reversed Z-plasty skin incision for Achilles tendon reconstruction. Foot Ankle Surg. 2002;8:277-280. https:// doi.org/10.1046/j.1460-9584.2002.00340.x.
  25. Ehrl D., Heidekrueger P.I., Schmitt A., Liska F., Ninkovic M., Giunta R. et al. The Anterolateral Thigh Flap for Achilles Tendon Reconstruction: Functional Outcomes. Plast Reconstr Surg. 2019;143(6):1772-1783. https://doi.org/10.1097/PRS.0000000000005652.
  26. Zhou L., Wei J., Liu L., Tao S., Dong Z. Composite sural neurocutaneous flap with gastrocnemius tendon for repairing defects of Achilles tendon and overlying soft tissue. J Orthop Surg (Hong Kong). 2020;28(3):2309499020971863. https://doi.org/10.1177/2309499020971863.

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2. Figure 1. Dissection of skin and adipofascial flaps: а — an arched skin incision; b — formation of a skin flap with the base facing medially; c — formation of a fascial flap with the base facing laterally

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3. Figure 2. Lengthening of the Achilles tendon, wound suturing and reconstruction of soft tissue defects: а — Achilles tendon lengthening using a Z-shaped incision; b — the Achilles tendon is covered with a fascial flap; c — partial wound suturing and full-thickness skin grafting

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