What Is Achilles Tendon Repair Surgery?

Fresh Achilles Tendon Rupture

Fresh Achilles Tendon Rupture

Right!

Fresh Achilles Tendon Rupture

Repair of fresh Achilles tendon rupture; repair of fresh Achilles tendon rupture

Orthopaedics / Surgery for Muscle, Tendon and Bursal Diseases / Surgery for Muscle and Tendon Rupture / Achilles Tendon Rupture

83.6401

Fresh Achilles tendon rupture repair is used to treat Achilles tendon rupture. Rupture of the Achilles tendon is usually caused by indirect or direct violence. The former occurs mostly during strenuous exercise, such as jumping, running, and gymnastics. The fracture site is mostly at the junction of the muscle and tendon and above the attachment point to the calcaneus. It is generally a closed injury with a ponytail-shaped stump. Rupture of the plantar tendon often does not occur, but there are also ruptures due to peritonitis and chronic injury, although it is only a mild contraction and violence. The latter mostly occurs in open injuries with sharp cuts, can occur at any age and location, and have a neat section. Although it is conducive to suture, it is still difficult to handle due to wound contamination and other injuries.

Fresh Achilles tendon rupture, sometimes still can actively plantar flexion, easy to cause missed diagnosis. Thompson introduced a reliable examination method: the patient was placed on his stomach and his feet extended beyond the end of the examination table. The examiner squeezed the gastrocnemius muscle of the affected calf with his hand. If the plantar flexion of the foot occurs at this time, the Achilles tendon is intact. Otherwise, it indicates that the Achilles tendon is broken. For fresh Achilles tendon rupture, after a clear diagnosis, if there is no contraindication, surgical repair can be performed immediately. Even in the early stages, there are significant differences in surgical difficulty between immediate sutures and 3 to 4 days delay in repair. Because the Achilles tendon ruptures, the gastrocnemius and soleus muscles are very strong, and the proximal end can be retracted far away. Early repair can avoid surgical difficulties caused by muscle contracture.

Fresh Achilles Tendon Rupture is suitable for:

1. Open Achilles Tendon Rupture.

2. Closed Achilles tendon rupture.

1. The general condition is poor and can not tolerate surgery.

2. Those with severe open pollution and local pollution.

Routine heel X-ray examination to understand whether the calcaneus has avulsion fractures.

Spinal or epidural anesthesia. Take the prone position.

Surgery related anatomy

1. Direct Suture

(1) Incision: Make a longitudinal incision along the medial or lateral edge of the Achilles tendon, approximately 10 cm long. Cut the tissues around the tendon and remove the local hematoma to reveal the two ends of the Achilles tendon. If it is an open injury, the original mouth can be extended appropriately. If it is a transverse wound, it can be extended up and down at its two ends.

(2) Suture the Achilles tendon: First trim the two ends, in order to reduce the tension, the knee joint can be flexed by 30 °, and the ankle joint should be flexed and sutured directly with silk thread. When the Achilles tendon abutment breaks, drill the bone hole obliquely downward from the back of the calcaneus with the hand drill, and enlarge the upper part. Use stainless steel wire to suture the proximal end of the Achilles tendon with "8" suture method and place Withdraw the wire, and then thread the wire out of the plantar skin through the bone hole of the calcaneus, and fix the wire to the button with the plantar flexion position.

If the tension is too large, stainless steel wire can be used to pull out the suture method. Use two straight needles to pass through the ends of a thin stainless steel wire. The straight needle at one end first penetrates into the Achilles tendon from the outer part of the proximal end of the Achilles tendon, and penetrates the outer edge of the Achilles tendon at 1.0 to 1.5 cm from the section. . Then traverse the Achilles tendon to the inner edge, and then pierce the Achilles tendon and penetrate the medial portion of the proximal section. Next, straight needles at both ends of the steel wire penetrated into the distal section of the Achilles tendon, and penetrated from the inside and outside of the Achilles tendon at a plane of 2.5 to 5.0 cm from the section. Then pass the skin out from the heel, tighten the wire to align the two ends of the Achilles tendon, remove the straight needle, and tie the wire to the gauze pads and buttons. Another thin wire was used to cover the inner upper corner of the previous wire, and the skin was penetrated near the center of the gastrocnemius muscle for future removal of the suture of the Achilles tendon.

(3) Suture the stump of the tendon intermittently with a medium-sized non-absorbable thread, and suture the subcutaneous tissue and skin.

2. Wide fascia strip cross repair (DecussationRepairwithWideFascia)

Take a broad fascia strip on the outside of the thigh, about 0.8cm wide and about 15cm long, and make a cross stitch between the stumps of the Achilles tendon.

3. Tendon flap repair (TendonSheathValveRepairOperation)

A pedicled aponeurotic flap is cut from the proximal segment of the Achilles tendon rupture, and its base is at a distance of 1 to 1.5 cm from the proximal end. The length and width of the pedicled aponeurotic flap may be overlapped with the distal end after sutured. When sutured, the ankle joint is flexed so that the two ends are closed and sutured, and then the pedicled aponeurotic flap is sutured and overlapped with the distal end. Finally, the proximal stump defect is sutured longitudinally and intermittently.

4. LindHolm Repair (LindHolmRepair)

(1) Incision: Make a posterior arc incision from the middle of the calf to the calcaneus. Cut the skin and subcutaneous tissue, and cut the deep fascia in the midline direction to reveal the Achilles tendon stump.

(2) Suture the Achilles tendon stump: Slightly debride the ends of the ruptured Achilles tendon, trim the stump, use thick silk or fine stainless steel wire for mattress suture, or intermittent suture with fine silk.

(3) Cut the pedicled tendon strip for repair: due to excessive tension after suture, a gap is often left at the two broken ends. Cut one Achilles tendon flap from each side of the proximal end of the ruptured Achilles tendon, 7.0 to 8.0 cm in length and 1.0 cm in width to the distal end. Their bases remain on the 3.0 cm plane on the proximal section of the Achilles tendon to make a smooth surface. Opposite the subcutaneous tissue, span the Achilles tendon defect, and suture the distal Achilles tendon. Suture the edges of the aponeurotic strips and the voids in the aponeurosis as well as the tissue and skin around the tendon.

5. Pedicled aponeurosis (RepairwithTendonSheathwithBase)

A suitable pedicled aponeurotic flap was cut from the surface of the Achilles tendon, and the Achilles tendon was not cut through. The base was located above the proximal section, and a longitudinal incision was made slightly above the tendon. After that, it is folded back down, and then the two sides of the Achilles tendon and the defects are wrapped backwards from both sides of the Achilles tendon.

6. Pedicled gastrocnemius skin flap repair (RepairwithGastrocnemiusMuscleFlapwithBase)

This operation is suitable for those with Achilles tendon rupture and skin defects. The upper part of the myocutaneous flap is located below the popliteal fossa, both sides to the inner edge of the tibia and the outer edge of the fibula, and the lower end to the proximal edge of the Achilles tendon and skin defects. A gap between the gastrocnemius muscle and the soleus muscle was found between them and separated bluntly. Then, the flap was lifted from near and far, and the attachment of the medial and lateral head and femur of the gastrocnemius muscle was cut to form an island muscle flap with vascular nerves, which was advanced to the distal end, and the gastrocnemius tendon was advanced to the Achilles tendon defect. The flexion is sutured with the distal end of the Achilles tendon to repair the Achilles tendon defect, and its skin is partially repaired to the wound surface, so that both Achilles tendon and skin defects are repaired.

7. Improved Ma and Griffith Surgery (ImproredMaandGriffithOperation)

(1) Make a 2cm long lateral central incision with the Achilles tendon rupture as the center, and then incision the skin, subcutaneous, fascia, and peri-tendon tissues in order to expose the stump of the distal and proximal Achilles tendon fractures, and extend the incision if necessary.

(2) The nerve stripper is used to make an introducer, that is, an elongated hole is drilled at the end of the stripper, and the introducer is inserted proximally between the inside and outside of the Achilles tendon and the tissue around the tendon.

(3) Use a long straight needle to insert a 7-0 silk thread, and insert the introducer hole through the skin, subcutaneous and perianal tissues respectively. After confirming that the needle or introducer is correct, pass the Achilles tendon to the contralateral introducer hole. Pull out, pull the introducer out of the incision, and pull out the ends of the sutures on both sides.

(4) Repeat the above procedure on different planes of the distal and proximal stumps of the Achilles tendon, and then bend the knees 90 ° and the ankle joints 20 ° to 30 °. Tighten the sutures to confirm that the gaps at the stumps disappear and ligate the sutures. Weekly organization coverage.

(5) Suture the peri-tendon tissue and fascial layer with absorbable thread in order, close the wound, and do not put the drainage strip.

(6) Keep the ankle joint in the plantar flexion position, tighten the suture to close the broken Achilles tendon, and tie the suture into the small skin incision. If necessary, close each small skin incision.

1. Try to protect the Achilles tendon membrane and the tissue around the tendon to avoid postoperative Achilles tendon adhesion and affect its functional recovery.

2. The plantar flexion position of the ankle joint should be kept unchanged to prevent excessive tension and lead to failure of repair.

3. Open injuries should be thoroughly debrided, pollution should be reduced as much as possible, and primary healing should be sought.

4. For the repair of the broken end section, too much can not be removed to prevent the difficulty of repair caused by the excessive suture tension of the defect.

5. Pay attention to the non-invasive operation technique, do not pull the incision skin margin too tightly and the subcutaneous separation is too wide to avoid local necrosis of the incision skin.

Postoperatively, the long leg cast was fixed at 20 ° 30 ° of knee flexion, and ankle joint plantar flexion. After 3 weeks, those who use the wire extraction method can remove the wire and replace the calf plaster to fix the ankle function. After 3 weeks, the fixation is removed and the ankle and gastrocnemius function are actively exercised.

1. Re-fracture after surgery is the main complication. It is closely related to the injury, the choice of operation mode, and the maintenance of knee and ankle flexion during and after surgery. Therefore, we must emphasize the choice of surgical methods and local fixation.

2. Complicated infection is a serious complication, which can lead to the failure of surgery and the difficulty of reoperation. It is related to factors such as preoperative pollution, incomplete debridement, and surgical operation.