Treatment of acute and closed Achilles tendon ruptures by minimally invasive tenocutaneous suturing

BACKGROUND
Achilles tendon rupture is a common injury, and its complications can impair function. Numerous operations have been described for reconstructing the ruptured tendon, but these methods can compromise microcirculation in the tendon and can seriously impair its healing. Suturing with a minimally invasive tenocutaneous technique soon after the rupture and systematic functional exercise can greatly reduce the possibility of complications.
METHODS
Between June 1996 and February 2009, we treated 88 patients (54 males; age range, 21-66 years) with this method.
RESULTS
After follow-up ranging from 1-7 years, the mean American Orthopedic Foot and Ankle Society ankle-hind foot score was 95 (range, 90-98), and the maximum length of postoperative scarring was 3 cm. One patient re-ruptured his Achilles tendon one year after surgery in an accident, but after 10 months, the repaired tendon was still intact. In another patient, the nervus suralis was damaged during surgery by piercing the tension suture at the near end, causing postoperative numbness and swelling. The tension suture was quickly removed, and the patient recovered well with conservative treatment. No large irregular scars, such as those sustained during immobilization, were present over the Achilles tendon.
CONCLUSION
Minimally invasive percutaneous suturing can restore the original length and continuity of the Achilles tendon, is minimally invasive, and has fewer postoperative complications than other methods.

Minimal invaziv tenokutanöz dikiþle akut ve kapalý Aþil tendonu yýrtýðýnýn tedavisi

AMAÇ
Aþil tendonu yýrtýðý sýk rastlanan bir yaralanmadýr, komplikasyonlarý iþlevini bozabilir. Yýrtýlmýþ tendonun rekonstrüksiyonu için sayýsýz operasyon tanýmlanmýþ olmasýna raðmen bu yöntemler tendonda mikrosirkülasyonu riske atabildiði gibi tendonun iyileþmesini ciddi derecede bozabilir. Yýrtýktan hemen sonra minimal invaziv tenokutanöz teknikle dikiþ atma ve sistemik fonksiyonel egzersiz, komplikasyon riskini büyük ölçüde azaltabilir.
GEREÇ VE YÖNTEM
Haziran 1996 ile Þubat 2009 arasýnda bu yöntemle 21-66 yaþ arasý 88 (54 erkek) hasta tedavi edildi.
BULGULAR
Bir ile 7 yýl arasý izlemden sonra ortalama (Amerikan Ortopedik Ayak ve Ayak Bileði Derneði (American Orthopedic Foot and Ankle Society) ayak bileði ayak arkasý skoru 95 (90-98 arasý) ve ameliyat sonrasý skarýn maksimal uzunluðu 3 cm idi. Bir hasta, cerrahiden 1 yýl sonra bir kazada Aþil tendonunu yeniden yýrtmýþtý. Ancak 10 ay sonra onarýlmýþ tendon hâlâ saðlamdý. Baþka bir hastada uca doðru atýlan gerim dikiþinin delip geçmesine baðlý olarak nervus suralis zedelendi, ameliyat sonrasý his kaybý ve ödeme neden oldu. Bu dikiþ hemen çýkartýldý ve hasta konservatif tedaviyle iyileþti. Aþil tendonu üzerinde uzun süre hareketsiz kalanlarda olduðu gibi düzensiz büyük skarlar yoktu.
SONUÇ
Minimal invaziv perkütanöz dikiþ Aþil tendonunun orijinal uzunluk ve bütünlüðünü saðlayabildiði gibi diðer yöntemlere göre ameliyat sonrasý komplikasyonlarý daha az olan minimal invaziv bir yöntemdir.