title: Debridement and Functional Rehabilitation for Achilles Tendon Infection Following Tendon Repair.
abstract: BACKGROUND
  An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon as well as the thin surrounding soft tissue. For treatment of an infected Achilles tendon following tendon repair, we first focused on complete debridement and then promoted fibrous scar healing of the Achilles tendon using functional treatment.
  
  
  METHODS
  We retrospectively reviewed all of the medical records of 15 tertiary referral patients with postoperative infection of the Achilles tendon occurring between 2007 and 2012. The mean follow-up time was 33 months (range, 22 to 97 months). The infected tissue and the necrotic tendon were debrided, and the ankle was placed in a short leg splint for 2 weeks. The splint was then replaced with an ankle brace for the next 4 weeks. Partial weight-bearing was allowed immediately, and full weight-bearing was allowed at 2 weeks postoperatively. We assessed and recorded the physical parameters such as the range of motion, calf circumference, ability to perform a single-limb heel rise, patient satisfaction, and Arner-Lindholm scale. Laboratory tests, postoperative ultrasonography, and isokinetic plantar flexion power tests were also performed.
  
  
  RESULTS
  At a mean time of 17 days (range, 8 to 30 days) after debridement, infection signs such as discharge from the wound, redness, and local warmth resolved. The wound had healed and the stitches were removed at a mean of 17 days following the wound repair. At the time of the latest follow-up, there were no signs of active infection. Achilles tendon continuity recovered in all patients by fibrous scar healing. Compared with the contralateral side, there was no difference in the ankle range of motion in 8 patients. According to the Arner-Lindholm scale, 9 of the 15 results were excellent and 6 were good. Ten patients were able to perform a single-limb heel rise. Eleven of 15 patients returned to their pre-injury recreational activities. Diffuse homogeneous echotexture of the Achilles tendon with continuity was observed on the ultrasonographic examination.
  
  
  CONCLUSIONS
  In this retrospective series, radical debridement, combined with antibiotic therapy and functional rehabilitation, was successful in eradicating infection and maintaining function in patients with postoperative infection following Achilles tendon repair.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Cheongju Ppuri Medical Center, Cheongju, Republic of Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Bae
authors.affiliation: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea hosng@amc.seoul.kr.
authors.forename: Ho-Seong
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Gyo
authors.initials: SG
authors.lastname: Seo
authors.affiliation: Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Heui-Chul
authors.initials: HC
authors.lastname: Gwak
authors.affiliation: Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
authors.forename: Su-Young
authors.initials: SY
authors.lastname: Bae
mesh_terms: D000125:Achilles Tendon / Q000382:microbiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000382:microbiology / Q000534:rehabilitation / Q000601:surgery; D012189:Retrospective Studies; D012421:Rupture / Q000534:rehabilitation / Q000601:surgery*; D013203:Staphylococcal Infections / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D013708:Tendon Injuries / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology