Authors: Nicholas B. Bruggeman, M.D.; Norman S. Turner, M.D.; Diane L. Dahm, M.D.; Tony Voll, R.N.; Tanya L. Hoskin, M.S.; David J. Jacofsky, M.D.; George J. Haidukewych, M.D.
Title: Wound Complications after Open Achilles Tendon Repair, An Analysis of Risk Factors
Address: Mayo Clinic 200 First Street SW Rochester, MN 55905
Purpose: The treatment of Achilles tendon ruptures remains controversial. To date no large series investigates the risk factors associated with developing wound healing and infection complications after operative repair of Achilles tendon ruptures. The purpose of this study is to retrospectively review a large series of consecutive Achilles tendon repairs performed at one institution to determine the risk factors associated with wound healing problems and infection.
Methods: Between 1978 and 2001, 165 consecutive open Achilles tendon repairs were performed at our institution. The patients were located via a diagnosis database at our Level 1 trauma center. Clinical data was retrospectively reviewed and results and complications analyzed. Risk factors such as tobacco abuse, diabetes, age, and steroid dependence were evaluated as potential risk factors for wound healing complications.
Results: There were 17 wound complications in 165 repairs (10.3%). Five patients developed deep infections. Two required soft tissue coverage (2 flaps); none resulted in below knee amputation. Five of 13 patients who used tobacco sustained wound healing complications (38.5%) compared with 7.9% in the nonsmoking group (RR 4.9, p = 0.005). One of 3 diabetic patients (33.3%) sustained a wound complication compared to 16 of 162 (9.9%) among non-diabetics. Three of the 6 patients who were steroid dependent (50%) sustained wound complications versus 14 (8.8%) among the 159 patients who were not steroid dependent. For those who had one or more of these risk factors present, 8/19 (42.1%) had a complication after surgery. Males seemed to have a decreased risk of wound complications (8.0%) relative to females (21.4%).
Discussion and Significance: Wound healing complications remain problematic after open operative repair of the Achilles tendon ruptures. Patients should be counseled that certain patient specific factors such as tobacco use, diabetes, steroid dependence, and age all influence the potential rates of wound complications. The majority of wound complications in this series were successfully managed with local care and antibiotics.