title: Outcome of skin graft versus flap surgery in the salvage of the exposed achilles tendon in diabetics versus nondiabetics.
abstract: BACKGROUND
  Achilles tendon wounds pose a reconstructive dilemma because of the tendon's functional importance and the paucity of soft tissue surrounding the ankle. The currently accepted treatment is to repair the wound with a flap (local, pedicled, or free). In this article, the authors examine whether skin graft coverage of the exposed Achilles tendon is a viable option for reconstruction and whether the comorbidity of diabetes affects the outcome.
  
  
  METHODS
  Forty-five consecutive patients presenting with wounds involving the Achilles tendon in 49 limbs were retrospectively evaluated from the authors' limb salvage registry from 1990 to 1999.
  
  
  RESULTS
  After initial debridement, the method of reconstruction consisted of closure by secondary intention (n = 6), skin grafting (n = 27), and reconstruction with a flap (n = 10) or free flaps (n = 6). The primary success rate of each procedure was not significantly different: secondary intention, 83 percent; skin graft, 83 percent; local flap, 80 percent; and free flap, 83 percent. The overall wound-healing rate was 96 percent and the limb salvage rate was 98 percent. Six wounds eventually recurred in patients who had undergone skin grafting. All but one went on to heal with conservative therapy. There was no difference in any of the result parameters between diabetics and nondiabetics.
  
  
  CONCLUSIONS
  This study demonstrates that, with a properly prepared wound bed, skin grafting can be as effective as local or free flaps in successfully healing Achilles tendon wounds. Diabetes should not be used as a contraindication to limb salvage in patients who present with Achilles tendon ulceration or gangrene.
authors.affiliation: The Limb Center, Georgetown University Hospital, Washington, DC 20007, USA. cattinger@aol.com
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
authors.forename: Ivica
authors.initials: I
authors.lastname: Ducic
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hess
authors.forename: Andreas
authors.initials: A
authors.lastname: Basil
authors.forename: Mark
authors.initials: M
authors.lastname: Abbruzzesse
authors.forename: Paul
authors.initials: P
authors.lastname: Cooper
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000009:adverse effects; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D016038:Skin Transplantation; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000209:etiology / Q000601:surgery*