Z-lengthening of the Achilles Tendon with Transverse Skin Incision

Abstract

BackgroundThe risk of various complications after Achilles tendon lengthening is mainly related to the length of surgical exposure and the lengthening method. A comprehensive technique to minimize the complications is required.MethodsThe treatment of Achilles tendon tightness in 57 patients (95 ankles) were performed by using a short transverse incision on a skin crease of the heel and by Z-lengthening of the tendon. In the severe cases, two or three transverse incisions were required for greater lengthening of the tendon, and a serial cast or Ilizarov apparatus was applied for the gradual correction. The results of these 95 ankles were compared to those of 18 ankles, which underwent percutaneous sliding lengthening, and to the 19 ankles, which received Z-lengthening with a medial longitudinal incision.ResultsThe functional and cosmetic satisfaction was achieved among those who underwent the tendon lengthening with the new technique. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 56.1 to 81.8. The second operations to correct recurrence were performed in the two cerebral palsy patients.ConclusionsThe new technique has a low rate of complications such as scarring, adhesion, total transection, excessive lengthening, and recurrence of shortening. The excellent cosmesis and the short operation time are the additional advantages.

Early management of neurologic clubfoot using Ponseti casting with minor posterior release in myelomeningocele

“…1). The neurologic TEV severity grade immediately postoperatively according to Diméglio was II (mean score 5.21; range 5-6) in 38 of 48 feet (79.2%), III (mean score 11.17; range 10-12) in six of 48 feet (12.5%), and IV (mean score 17.75; range [16][17][18][19] in four of 48 feet (8.3%). At the last follow-up visit, grade Three infants (5/48 feet; 10.4%) failed to show any improvement from their initial deformity and were treated with the standard posteromedial release.…”

“…They showed very severe (grade IV in 28 of 48 feet, mean score 12.8; range [12][13][14] to severe (grade III in 20 of 48 feet, mean score 17; range [15][16][17][18][19] equinovarus deformity before management according to the system of Diméglio et al [13].…”

“…In addition, percutaneous tenotomy is not suitable for those children with myelomeningoceles who often present with stiff and rigid deformity. It is suitable for patients with mild and moderate contracture [17,19]. Furthermore, this approach offers better access intraoperatively to posterior capsulotomy if the deformity is still not corrected.…”

“…We believe that this method is better than the percutaneous tenotomy as described by Ponseti. It has the advantage of enabling accurate Achilles lengthening with a lower recurrence rate [17] and fewer bleeding complications [18] compared with percutaneous tenotomy. In addition, percutaneous tenotomy is not suitable for those children with myelomeningoceles who often present with stiff and rigid deformity.…”

Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

“…e rotation can disperse the stress and avoid Achilles tendon injury; it may also increase the di culty of percutaneous Achilles tendon lengthening. Achilles tendon torsion can lead to failure in Achilles tendon lengthening procedures [20]. us, the distance between the most distal incision and middle incision was controlled at 5 cm in our study.…”