Reconstruction of iatrogenic skin defects of the Achilles tendon region: an analysis of 25 consecutive patients

Abstract

Achilles tendon surgery is quite common, typical indications being acute tendon rupture and chronic tendinitis. Post-operative wound infection or skin necrosis occurs in 2.4–5% of these operations. Soft tissue reconstruction of the Achilles tendon region presents a challenge due to the limited amount of local tissue available. We interviewed 25 consecutive patients with a post-operative skin defect, caused by infection or skin necrosis, after Achilles tendon surgery at mean 30 (range 6–56) months after reconstructive surgery. Of the patients 12 had acute tendon rupture and 13 had chronic tendinitis. The method of reconstruction after debridement was direct closure in one, total revision of the tendon and free skin graft in four, local flap in three, bipedicle skin flap in 10 and free microvascular flap in seven. All patients healed without event, however the patients whose reconstruction was done with a free flap had a somewhat slower return to work (mean 2.25 months vs 1.9 months) and had, after physical activity, pain in the operated area. We conclude that the type of soft tissue reconstruction in the Achilles area should depend on the size and shape of the defect as well as the general health of the patient.