Traitement des nécroses du tendon d’Achille sans reconstruction tendineuse : à propos de quatre cas

Monnerie, C.; Nen, D. Le; Hu, Weiguo; Letissier, Hoël; Kerfant, N.

doi:10.1016/j.anplas.2019.01.004

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…Thereafter, many authors reported similar strategy for management of their cases with infected Achilles tendon. 15,[26][27][28] Despite being totally different from rupture and injury of the tendon which occur in athletes, no study addressed the management of infected and necrotic Achilles tendon in diabetic patients. In diabetic patients, although tendon preservation to maintain walking and daily activity is important but when diabetic foot infection occurs limb salvage becomes a priority accepting the trade-off of potential limitations of movement.…”

Section: Discussionmentioning

confidence: 99%

Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Aborahma

Sallam

Nagy

2023

Ain Shams Journal of Surgery

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Background: Infected Achilles tendon is difficult to manage especially in diabetic patients. Total excision of the infected tendon may provide better option for limb salvage in these patients where altered walking pattern can minimize expected subsequent functional impairment.Patients and methods: 35 diabetics with infected Achilles tendon were enrolled in this study. Nineteen patients underwent complete tendon excision (Group A) while in the remaining 16 patients, the tendon was partially excised (Group B). After wound approximation, negative pressure was applied to achieve healing by secondary intention. Initial immobilization and splinting were done followed by gradual weight bearing. Heel-rise test, activity limitation, walking difficulty on different surfaces and gait abnormalities were used to assess functional outcome.Results: Group A had significantly larger ulcer size compared to Group B (9.23 ± 2.04 vs 7.35 ± 3.30 cm2, P = 0.05). Also, mean ulcer duration was significantly longer in Group A (2.53 ± 0.75 vs 1.09 ± 0.49 months, P < 0.001). Group A showed significantly shorter healing time (3.14 ± 0.79 vs 7.05 ± 1.56 months, P < 0.001), shorter follow-up period (5.32 ± 1.6 vs 8.25 ± 2.94 months, P = 0.001) and lower reintervention rate (5.26% vs 56.25%, P < 0.001) compared to Group B. Functional assessment showed more limitation in heel-rise in total excision group, yet without significant limitation in other functional parameters, including walking ability. Conclusion:Total excision of infected Achilles tendon in diabetic patients can give higher healing success rates with minimal functional impairment compared to partial tendon excision.

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Section: Discussionmentioning

confidence: 99%

Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Aborahma

Sallam

Nagy

2023

Ain Shams Journal of Surgery

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“…Several surgical interventions have been described for reconstruction of soft tissue defects, ranging from secondary skin healing to use of free flaps and amputation; the choice depends upon exposure of vital structures and tissue vascularity. 12,13 According to Monnere et al 14 , adequate neo-Achilles tendon can be formed with skin-soft tissue reconstruction without Achilles tendon repair. However, according to a meta-analysis by Ochen et al 15 , operative treatment is associated with reduced rate of re-rupture of the Achilles tendon.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of Achilles region defects: a single-center experience

Eser¹,

Ceylan²,

Gencel³

et al. 2021

Preprint

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Background: Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to use of free flaps. Method: In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single center. Results: Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6), and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Conclusion: Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. Use of special digital imaging techniques facilitates flap surgery and helps minimize the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Superthin free flaps offer a distinct advantage in skillful hands. Use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favorable outcomes.

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“…The flexible use of tissue engineering in rehabilitation medicine provides the most favorable support and assurance for repairing Achilles tendon defects. Although there are many surgical approaches to repairing Achilles tendon defects in modern regenerative medicine, there is still no consensus on the simplest, most effective, and safest technique (Chugaev et al, 2018;Monnerie et al, 2019). At this stage, ultrasound imaging is used clinically to examine the early healing of Achilles tendon defects.…”

Section: Open Accessmentioning

confidence: 99%

Poly (trimethylene carbonate)/doxycycline hydrochloride films in the treatment of Achilles tendon defect in rats

Zhang

Zhang²,

Li³

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: In this study, Poly (trimethylene carbonate)/Doxycycline hydrochloride (PTMC/DH) films were introduced to repair the Achilles tendon defects for the first time.Methods: (PTMC/DH) films with different DH content of 10, 20, and 30% (w/w) were prepared by solvent casting. The in vitro and in vivo drug release of the prepared PTMC/DH films was investigated.Results: The results of drug release experiments showed that the PTMC/DH films released effective concentrations of doxycycline for more than 7 and 28 days in vitro and in vivo, respectively. The results of antibacterial activity experiments showed diameters of 25.00 ± 1.00 mm, 29.33 ± 1.15 mm, and 34.67 ± 1.53 mm, respectively, for the inhibition zones produced by the release solutions of PTMC/DH films with 10, 20 and 30% (w/w) DH at 2 h, indicating that the drug-loaded films could inhibit Staphylococcus aureus well. After treatment, the Achilles tendon defects have recovered well, as indicated by the more robust biomechanical properties and the lower fibroblast density of the repaired Achilles tendons. Pathology revealed that the pro-inflammatory cytokine, IL-1β, and the anti-inflammatory factor, TGF-β1, peaked in the first three days and gradually decreased as the drug was released more slowly.Discussion: These results demonstrated that the PTMC/DH films have great potential for regenerating Achilles tendon defects.

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Traitement des nécroses du tendon d’Achille sans reconstruction tendineuse : à propos de quatre cas

Cited by 7 publications

References 13 publications

Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Reconstruction of Achilles region defects: a single-center experience

Poly (trimethylene carbonate)/doxycycline hydrochloride films in the treatment of Achilles tendon defect in rats

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