title: Surgical repair of acute Achilles tendon rupture with an end-to-end tendon suture and tendon flap.
abstract: BACKGROUND
  Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2-8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique.
  
  
  METHODS
  In 8 patients with acute rupture of Achilles tendon the surgery was performed at least 25 days after trauma. Clinical exam and MR demonstrated in all case a total lesion of tendon. After a posterolateral skin incision the tendon stumps were debrided and suture in end-to-end fashion. A tendon flap was harvested from the proximal part of the tendon, in order to protect and reinforce the suture itself. A plaster cast was applied for 3 weeks and the patients started the rehabilitation protocol.
  
  
  RESULTS
  After 4 months all patients returned to pre-injury daily activities. The mean follow up was 13 months (ranged between 6 and 24 months). No major complications occurred.
  
  
  CONCLUSIONS
  The posterolateral skin incision, not above the tendon, preserves the vascularity of the soft tissues, allows identifying and not accidentally injuring the sural nerve, and prevents the cutaneous scar is overlapped the tendon. In this way is favoured physiological tendon sliding. The preparation of the flap tendon does not weaken the overall strength of the tendon and protects the tendon suture. The tension on sutured stumps is less than being spread over a larger area. In our sample of 8 patients the absence of short-and long-term complications and the rapid functional recovery after surgery suggest that the technique used is safe and effective.
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Sez. Chirurgia Plastica, Università di Palermo, Italy. Electronic address: bartolo.corradino@unipa.it.
authors.forename: B
authors.initials: B
authors.lastname: Corradino
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Sez. Chirurgia Plastica, Università di Palermo, Italy. Electronic address: dilsister@libero.it.
authors.forename: S
authors.initials: S
authors.lastname: Di Lorenzo
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Sez. Chirurgia Plastica, Università di Palermo, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Calamia
authors.affiliation: Dipartimento di Discipline Chirurgiche, Oncologiche e Stomatologiche, Sez. Chirurgia Plastica, Università di Palermo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Moschella
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D005260:Female; D005402:Fistula; D005500:Follow-Up Studies; D006099:Granuloma; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012421:Rupture / Q000534:rehabilitation; D013524:Surgical Flaps; D013530:Surgical Wound Infection; D013536:Suture Techniques; D013708:Tendon Injuries / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing
keywords: Achilles tendon rupture; Surgical treatment of tendon rupture, Achilles tendon injury