Open Achilles tendon lacerations

Abstract

In contrast to closed Achilles tendon ruptures, open injuries are rarely reported in the literature. This paper provides information about open Achilles tendon wounds that are eventually seen in the Middle East. The reporting unit, Hamad Medical Corporation, is one of the biggest trauma centers in the Gulf area and the major health provider in Qatar. This is a retrospective study including patients admitted and operated for open Achilles tendon injuries between January 2011 and December 2013. Two hundred and five cases of open Achilles tendon lacerations were operated in Hamad General Hospital in this period. Forty-eight cases showed partial injuries, and the remaining are complete tendons cut. In the same period, fifty-one closed ruptured Achilles tendons were operated in the same trauma unit. In the majority of cases, the open injury resulted from a slip in the floor-leveled traditional toilette seats. Local damage to the toilette seats resulted in sharp edges causing the laceration of the heel if the patient was slipping over the wet floor. This occurrence is the cause in the vast majority of the cases. Wounds were located 1-5 cm proximal to tendon insertion. Standard treatment principles were applied. This included thorough irrigation in the emergency room, intravenous antibiotics, surgical debridement and primary repair within 24 h. Patients were kept in the hospital 1-7 days for intravenous antibiotics and possible dressing changes. Postoperatively below knee slabs were applied in the majority of patients and were kept for about 4 weeks followed by gradual weight bearing and range of motion exercises. Outpatients follow up in 1-2 weeks. Further follow-up visits at around 2-, 4-, 8- and 12-week intervals until complete wound healing and satisfactory rehabilitation outcome. Sixteen cases needed a second procedure. A high incidence of Achilles tendon open injuries is reported. This seems to be related to partially damaged floor-level toilettes in the typical Middle-East lavatory. The surgical treatment resulted in excellent outcome in the vast majority of the cases. Low incidence of complications resulted despite dramatic injury pattern.

13‐year‐old with left heel injury

“…Literature on AT lacerations is sparse, particularly in the pediatric population. 1 , 2 Other AT injuries, such as AT ruptures, commonly are seen in middle‐aged men involved in sports with an incidence of roughly 18 per 100,000 people. 3 In contrast, AT lacerations most commonly are caused by bicycle spoke injuries 4 , non‐lethal weapons 5 , and lawn mowers.…”

“…Literature on AT lacerations is sparse, particularly in the pediatric population 1,2 . Other AT injuries, such as AT ruptures, commonly are seen in middle‐aged men involved in sports with an incidence of roughly 18 per 100,000 people 3 .…”

Classification of Wounds: Know before Research and Clinical Practice

“…These are caused by both internal or external factors like childbirth or punching body, respectively [17][18][19] [22,23].…”

“Repair and Flap technique”: A Retrospective Analysis of Single Stage Reconstruction Method for Treatment of Chronic Open Achilles Tendon Defect with Proximal Turndown Flap and Reverse Sural Flap

“…Composite defects of the Achilles tendon are observed following road traffic accidents and accidental slipping of the foot in the Indian type lavatory [1,2]. Repair of composite Achilles tendon defects is a contentious issue regarding the timing [Immediate or delayed], stages [single stage or two stage] and primary application of flaps [3]. The management of acute wounds in Achilles tendon region is debridement and immediate repair of tendon.…”