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.	张强, 彭亮, 巫宗德, 等. 急性跟腱断裂手术治疗进展. 中国运动医学杂志, 2018, 37(3): 267-272.
2.	马文明, 丁亮华, 何双华, 等. 超声辅助下经皮微创治疗急性闭合性跟腱断裂. 中华创伤杂志, 2017, 33(5): 441-446.
3.	方家刘, 詹俊锋, 李军, 等. 急性闭合性跟腱断裂的治疗进展. 中华骨科杂志, 2018, 38(1): 53-59.
4.	姜健, 孙强, 苏云, 等. 改良跟腱内侧弧形切口联合改良垂直间断褥式缝合法治疗新鲜跟腱断裂. 实用骨科杂志, 2019, 25(1): 84-86.
5.	余炯杰, 颜丹, 李甲, 等. 急性闭合性跟腱断裂手术治疗进展. 实用骨科杂志, 2017, 23(9): 820-823.
6.	李伟, 黄壮乐. 微创Kessler缝合结合快速康复对急性闭合性跟腱断裂的疗效研究. 医学美学美容, 2021, 30(7): 41-42.
7.	胡元斌, 李永顺, 周岳来, 等. Kessler缝合法结合带线锚钉手术治疗急性闭合性跟腱断裂临床疗效分析. 重庆医学, 2019, 48(23): 4114-4115.
8.	杨英, 程安源, 徐立, 等. 经通道辅助缝合系统微创手术治疗急性闭合性跟腱断裂疗效分析. 中国骨与关节损伤杂志, 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, 丰景斌, 王维学, 等. 不同缝合方式治疗急性闭合性跟腱断裂的效果比较. 中国临床医生杂志, 2020, 48(10): 1231-1234.
12.	Karaaslan F, Mermerkaya MU, Çıraklı 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.	王晓宁, 朱颖波, 黄鑫, 等. 新型微创缝合技术治疗急性闭合性跟腱断裂. 中华创伤骨科杂志, 2016, 18(3): 187-191.
14.	Taşatan E, Emre TY, Demircioğlu 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.	杨明, 张晓萌, 张殿英, 等. 两种微创技术治疗跟腱断裂的比较研究. 中华创伤骨科杂志, 2016, 18(3): 192-196.
16.	高剑锐, 冯德宏, 丁育健. 改良入路手术治疗急性闭合性跟腱断裂18例. 中国骨与关节损伤杂志, 2020, 35(6): 650-651.
17.	胡峰, 李育泉, 刘伟, 等. 微创Kessler缝合治疗急性闭合性跟腱断裂的疗效观察. 中国医学工程, 2021, 29(1): 44-47.
18.	杨治涛, 焦义, 韩南影, 等. 腱旁小切口Krackow法缝合急性闭合性跟腱断裂. 中国矫形外科杂志, 2020, 28(18): 1709-1711.
19.	马云飞, 张晶, 姜楠, 等. 急性闭合性跟腱断裂的最新诊疗进展. 中华创伤骨科杂志, 2021, 23(4): 323-328.
20.	汤明, 魏世隽, 齐凤宇, 等. 微创缝合联合术后早期加速康复治疗急性跟腱断裂的临床研究. 创伤外科杂志, 2021, 23(4): 296-300.

1. 张强, 彭亮, 巫宗德, 等. 急性跟腱断裂手术治疗进展. 中国运动医学杂志, 2018, 37(3): 267-272.
2. 马文明, 丁亮华, 何双华, 等. 超声辅助下经皮微创治疗急性闭合性跟腱断裂. 中华创伤杂志, 2017, 33(5): 441-446.
3. 方家刘, 詹俊锋, 李军, 等. 急性闭合性跟腱断裂的治疗进展. 中华骨科杂志, 2018, 38(1): 53-59.
4. 姜健, 孙强, 苏云, 等. 改良跟腱内侧弧形切口联合改良垂直间断褥式缝合法治疗新鲜跟腱断裂. 实用骨科杂志, 2019, 25(1): 84-86.
5. 余炯杰, 颜丹, 李甲, 等. 急性闭合性跟腱断裂手术治疗进展. 实用骨科杂志, 2017, 23(9): 820-823.
6. 李伟, 黄壮乐. 微创Kessler缝合结合快速康复对急性闭合性跟腱断裂的疗效研究. 医学美学美容, 2021, 30(7): 41-42.
7. 胡元斌, 李永顺, 周岳来, 等. Kessler缝合法结合带线锚钉手术治疗急性闭合性跟腱断裂临床疗效分析. 重庆医学, 2019, 48(23): 4114-4115.
8. 杨英, 程安源, 徐立, 等. 经通道辅助缝合系统微创手术治疗急性闭合性跟腱断裂疗效分析. 中国骨与关节损伤杂志, 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, 丰景斌, 王维学, 等. 不同缝合方式治疗急性闭合性跟腱断裂的效果比较. 中国临床医生杂志, 2020, 48(10): 1231-1234.
12. Karaaslan F, Mermerkaya MU, Çıraklı 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. 王晓宁, 朱颖波, 黄鑫, 等. 新型微创缝合技术治疗急性闭合性跟腱断裂. 中华创伤骨科杂志, 2016, 18(3): 187-191.
14. Taşatan E, Emre TY, Demircioğlu 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. 杨明, 张晓萌, 张殿英, 等. 两种微创技术治疗跟腱断裂的比较研究. 中华创伤骨科杂志, 2016, 18(3): 192-196.
16. 高剑锐, 冯德宏, 丁育健. 改良入路手术治疗急性闭合性跟腱断裂18例. 中国骨与关节损伤杂志, 2020, 35(6): 650-651.
17. 胡峰, 李育泉, 刘伟, 等. 微创Kessler缝合治疗急性闭合性跟腱断裂的疗效观察. 中国医学工程, 2021, 29(1): 44-47.
18. 杨治涛, 焦义, 韩南影, 等. 腱旁小切口Krackow法缝合急性闭合性跟腱断裂. 中国矫形外科杂志, 2020, 28(18): 1709-1711.
19. 马云飞, 张晶, 姜楠, 等. 急性闭合性跟腱断裂的最新诊疗进展. 中华创伤骨科杂志, 2021, 23(4): 323-328.
20. 汤明, 魏世隽, 齐凤宇, 等. 微创缝合联合术后早期加速康复治疗急性跟腱断裂的临床研究. 创伤外科杂志, 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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