title: Open achilles tendon defects: a 12-year study on the injury mechanisms, reconstructions, and late complications.
abstract: BACKGROUND
  Open injuries of the Achilles tendon, which can be complicated by skin and bone injuries, continue to be a great challenge for surgeons. This study aims to report our experience with treatment of open Achilles tendon defects, focusing on the injury mechanisms, soft tissue coverage and late complications.
  
  
  METHODS
  A retrospective review was performed on 31 patients with open Achilles tendon defects between 1999 and 2011. The analyzed factors were injury mechanisms, surgeries, and long follow-up complications. The defect lengths of the Achilles tendons in the study ranged from 1 to 11 cm and the soft tissue defects ranged from 3 × 3 to 12 × 10 cm. Nine types of flaps were used for the coverage of concomitant skin defects.
  
  
  RESULTS
  Motorcycle spoke injuries were the most common cause of injury. There was no complete flap loss or rerupture of the reconstructed Achilles tendon. At the latest follow-up, all limbs were preserved and all the patients had regained full walking abilities. The algorithm of one-stage reconstruction was established, according to the defect length of the Achilles tendon and the defect size of skin. Late complications included maximum dorsiflexion loss and failure of heel raising ability on the single reconstructed foot.
  
  
  CONCLUSIONS
  Open Achilles tendon defects are characteristic of concurrent skin and bone injuries and the reconstruction protocols of the different tissues should not be separated.
authors.affiliation: Department of Orthopaedic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China.
authors.forename: Yue-Liang
authors.initials: YL
authors.lastname: Zhu
authors.affiliation: Department of Orthopaedic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China.
authors.forename: Yong-Qing
authors.initials: YQ
authors.lastname: Xu
authors.affiliation: Department of Orthopaedic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China.
authors.forename: Liang-Bin
authors.initials: LB
authors.lastname: Mei
authors.affiliation: Department of Orthopaedic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China.
authors.forename: Fu-Bing
authors.initials: FB
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, Yunnan Province, China.
authors.forename: Lin-Hui
authors.initials: LH
authors.lastname: Sun
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D001642:Bicycling; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005205:Fascia / Q000098:blood supply* / Q000637:transplantation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D011183:Postoperative Complications / Q000503:physiopathology*; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply*; D013708:Tendon Injuries / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome