Application of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in acute closed Achilles tendon rupture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Caifeng ^1,2 ,  DING Xiaoheng ¹ , WANG Zhengdan ¹ , REN Shengquan ¹ , LIU Chunlei ¹

1. Department of Hand Surgery, No. 971 Naval Hospital of PLA, Qingdao Shandong, 266000, P.R.China;
2. Department of Orthopedics, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China;

Corresponding?author：

DING Xiaoheng, Email: dxhqd@126.com

Keywords：

Achilles tendon rupture; surgical incision; Achilles tendon suture

DOI：

10.7507/1002-1892.202102025

Video：

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Objective To explore the effectiveness of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in the treatment of acute closed Achilles tendon rupture.Methods The clinical data of 32 patients with acute closed Achilles tendon rupture who met the selection criteria between August 2015 and February 2019 were retrospectively analyzed. There were 25 males and 7 females, with an average age of 33 years (range, 21-48 years). All of them were closed rupture of Achilles tendon caused by sports injury. Physical examination on admission: the rupture space of Achilles tendon was palpable; Thompson sign was positive; the rupture of Achilles tendon was confirmed by MRI and ultrasonography before operation, the distance between the broken end and the insertion point of Achilles tendon was 2-8 cm, with an average of 3.5 cm. The average time from injury to operation was 2.7 days (range, 1-10 days). During the operation, the posterior median longitudinal W-shaped incision of Achilles tendon was used to expose the broken end of Achilles tendon, and the deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture were used to suture the Achilles tendon, and the skin incision was sutured by “V-Y”advancement. The postoperative complications were observed; the healing of Achilles tendon was observed by ultrasonography; at last follow-up, Arner Lindholm criteria was used to evaluate ankle function.Results The 32 patients were followed up 8-24 months, with an average of 12 months. The incision healed by first intention, without the complications of skin necrosis, nonunion, delayed healing, and infection, scar hyperplasia or ulcer, and symptom of peroneal nerve injury. No Achilles tendon rupture and deep infection occurred during the follow-up period. The ultrasonography examination showed that the Achilles tendon was healing. At last follow-up, according to Amer Lindholm evaluation standard, the results of ankle function was excellent in 26 cases and good in 6 cases.Conclusion The treatment of acute closed Achilles tendon rupture with a posterior median longitudinal W-shaped incision combined with deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture is effective, which can fully exposed the incision, the quality of Achilles tendon anastomosis is reliable, and it can effectively avoid wound complications and iatrogenic injury of gastrocnemius nerve.

Citation： WU Caifeng, DING Xiaoheng, WANG Zhengdan, REN Shengquan, LIU Chunlei. Application of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in acute closed Achilles tendon rupture. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(8): 946-949. doi: 10.7507/1002-1892.202102025 Copy

1.	張強, 彭亮, 巫宗德, 等. 急性跟腱斷裂手術治療進展. 中國運動醫學雜志, 2018, 37(3): 267-272.
2.	馬文明, 丁亮華, 何雙華, 等. 超聲輔助下經皮微創治療急性閉合性跟腱斷裂. 中華創傷雜志, 2017, 33(5): 441-446.
3.	方家劉, 詹俊鋒, 李軍, 等. 急性閉合性跟腱斷裂的治療進展. 中華骨科雜志, 2018, 38(1): 53-59.
4.	姜健, 孫強, 蘇云, 等. 改良跟腱內側弧形切口聯合改良垂直間斷褥式縫合法治療新鮮跟腱斷裂. 實用骨科雜志, 2019, 25(1): 84-86.
5.	余炯杰, 顏丹, 李甲, 等. 急性閉合性跟腱斷裂手術治療進展. 實用骨科雜志, 2017, 23(9): 820-823.
6.	李偉, 黃壯樂. 微創Kessler縫合結合快速康復對急性閉合性跟腱斷裂的療效研究. 醫學美學美容, 2021, 30(7): 41-42.
7.	胡元斌, 李永順, 周岳來, 等. Kessler縫合法結合帶線錨釘手術治療急性閉合性跟腱斷裂臨床療效分析. 重慶醫學, 2019, 48(23): 4114-4115.
8.	楊英, 程安源, 徐立, 等. 經通道輔助縫合系統微創手術治療急性閉合性跟腱斷裂療效分析. 中國骨與關節損傷雜志, 2020, 35(6): 647-649.
9.	Yang B, Liu Y, Kan S, et al. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg, 2017, 40: 178-186.
10.	Huang X, Huang G, Ji Y, et al. Augmented repair of acute Achilles tendon rupture using an allograft tendon weaving technique. J Foot Ankle Surg, 2015, 54(6): 1004-1009.
11.	符仲秋, 豐景斌, 王維學, 等. 不同縫合方式治療急性閉合性跟腱斷裂的效果比較. 中國臨床醫生雜志, 2020, 48(10): 1231-1234.
12.	Karaaslan F, Mermerkaya MU, ??rakl? A, et al. Surgical versus conservative treatment following acute rupture of the Achilles tendon: is there a pedobarographic difference? Ther Clin Risk Manag, 2016, 12: 1311-1315.
13.	王曉寧, 朱穎波, 黃鑫, 等. 新型微創縫合技術治療急性閉合性跟腱斷裂. 中華創傷骨科雜志, 2016, 18(3): 187-191.
14.	Ta?atan E, Emre TY, Demircio?lu DT, et al. Long-term results of mini-open repair technique in the treatment of acute achilles tendon rupture: A prospective study. J Foot Ankle Surg, 2016, 55(5): 971-975.
15.	楊明, 張曉萌, 張殿英, 等. 兩種微創技術治療跟腱斷裂的比較研究. 中華創傷骨科雜志, 2016, 18(3): 192-196.
16.	高劍銳, 馮德宏, 丁育健. 改良入路手術治療急性閉合性跟腱斷裂18例. 中國骨與關節損傷雜志, 2020, 35(6): 650-651.
17.	胡峰, 李育泉, 劉偉, 等. 微創Kessler縫合治療急性閉合性跟腱斷裂的療效觀察. 中國醫學工程, 2021, 29(1): 44-47.
18.	楊治濤, 焦義, 韓南影, 等. 腱旁小切口Krackow法縫合急性閉合性跟腱斷裂. 中國矯形外科雜志, 2020, 28(18): 1709-1711.
19.	馬云飛, 張晶, 姜楠, 等. 急性閉合性跟腱斷裂的最新診療進展. 中華創傷骨科雜志, 2021, 23(4): 323-328.
20.	湯明, 魏世雋, 齊鳳宇, 等. 微創縫合聯合術后早期加速康復治療急性跟腱斷裂的臨床研究. 創傷外科雜志, 2021, 23(4): 296-300.

1. 張強, 彭亮, 巫宗德, 等. 急性跟腱斷裂手術治療進展. 中國運動醫學雜志, 2018, 37(3): 267-272.
2. 馬文明, 丁亮華, 何雙華, 等. 超聲輔助下經皮微創治療急性閉合性跟腱斷裂. 中華創傷雜志, 2017, 33(5): 441-446.
3. 方家劉, 詹俊鋒, 李軍, 等. 急性閉合性跟腱斷裂的治療進展. 中華骨科雜志, 2018, 38(1): 53-59.
4. 姜健, 孫強, 蘇云, 等. 改良跟腱內側弧形切口聯合改良垂直間斷褥式縫合法治療新鮮跟腱斷裂. 實用骨科雜志, 2019, 25(1): 84-86.
5. 余炯杰, 顏丹, 李甲, 等. 急性閉合性跟腱斷裂手術治療進展. 實用骨科雜志, 2017, 23(9): 820-823.
6. 李偉, 黃壯樂. 微創Kessler縫合結合快速康復對急性閉合性跟腱斷裂的療效研究. 醫學美學美容, 2021, 30(7): 41-42.
7. 胡元斌, 李永順, 周岳來, 等. Kessler縫合法結合帶線錨釘手術治療急性閉合性跟腱斷裂臨床療效分析. 重慶醫學, 2019, 48(23): 4114-4115.
8. 楊英, 程安源, 徐立, 等. 經通道輔助縫合系統微創手術治療急性閉合性跟腱斷裂療效分析. 中國骨與關節損傷雜志, 2020, 35(6): 647-649.
9. Yang B, Liu Y, Kan S, et al. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg, 2017, 40: 178-186.
10. Huang X, Huang G, Ji Y, et al. Augmented repair of acute Achilles tendon rupture using an allograft tendon weaving technique. J Foot Ankle Surg, 2015, 54(6): 1004-1009.
11. 符仲秋, 豐景斌, 王維學, 等. 不同縫合方式治療急性閉合性跟腱斷裂的效果比較. 中國臨床醫生雜志, 2020, 48(10): 1231-1234.
12. Karaaslan F, Mermerkaya MU, ??rakl? A, et al. Surgical versus conservative treatment following acute rupture of the Achilles tendon: is there a pedobarographic difference? Ther Clin Risk Manag, 2016, 12: 1311-1315.
13. 王曉寧, 朱穎波, 黃鑫, 等. 新型微創縫合技術治療急性閉合性跟腱斷裂. 中華創傷骨科雜志, 2016, 18(3): 187-191.
14. Ta?atan E, Emre TY, Demircio?lu DT, et al. Long-term results of mini-open repair technique in the treatment of acute achilles tendon rupture: A prospective study. J Foot Ankle Surg, 2016, 55(5): 971-975.
15. 楊明, 張曉萌, 張殿英, 等. 兩種微創技術治療跟腱斷裂的比較研究. 中華創傷骨科雜志, 2016, 18(3): 192-196.
16. 高劍銳, 馮德宏, 丁育健. 改良入路手術治療急性閉合性跟腱斷裂18例. 中國骨與關節損傷雜志, 2020, 35(6): 650-651.
17. 胡峰, 李育泉, 劉偉, 等. 微創Kessler縫合治療急性閉合性跟腱斷裂的療效觀察. 中國醫學工程, 2021, 29(1): 44-47.
18. 楊治濤, 焦義, 韓南影, 等. 腱旁小切口Krackow法縫合急性閉合性跟腱斷裂. 中國矯形外科雜志, 2020, 28(18): 1709-1711.
19. 馬云飛, 張晶, 姜楠, 等. 急性閉合性跟腱斷裂的最新診療進展. 中華創傷骨科雜志, 2021, 23(4): 323-328.
20. 湯明, 魏世雋, 齊鳳宇, 等. 微創縫合聯合術后早期加速康復治療急性跟腱斷裂的臨床研究. 創傷外科雜志, 2021, 23(4): 296-300.

Chinese Journal of Reparative and Reconstructive Surgery

Application of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in acute closed Achilles tendon rupture

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