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Title: [Application of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in acute closed Achilles tendon rupture].
Author: Wu C, Ding X, Wang Z, Ren S, Liu C.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Aug 15; 35(8):946-949. PubMed ID: 34387419.
Abstract:
OBJECTIVE: To explore the effectiveness of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in the treatment of acute closed Achilles tendon rupture. METHODS: The clinical data of 32 patients with acute closed Achilles tendon rupture who met the selection criteria between August 2015 and February 2019 were retrospectively analyzed. There were 25 males and 7 females, with an average age of 33 years (range, 21-48 years). All of them were closed rupture of Achilles tendon caused by sports injury. Physical examination on admission: the rupture space of Achilles tendon was palpable; Thompson sign was positive; the rupture of Achilles tendon was confirmed by MRI and ultrasonography before operation, the distance between the broken end and the insertion point of Achilles tendon was 2-8 cm, with an average of 3.5 cm. The average time from injury to operation was 2.7 days (range, 1-10 days). During the operation, the posterior median longitudinal W-shaped incision of Achilles tendon was used to expose the broken end of Achilles tendon, and the deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture were used to suture the Achilles tendon, and the skin incision was sutured by "V-Y"advancement. The postoperative complications were observed; the healing of Achilles tendon was observed by ultrasonography; at last follow-up, Arner Lindholm criteria was used to evaluate ankle function. RESULTS: The 32 patients were followed up 8-24 months, with an average of 12 months. The incision healed by first intention, without the complications of skin necrosis, nonunion, delayed healing, and infection, scar hyperplasia or ulcer, and symptom of peroneal nerve injury. No Achilles tendon rupture and deep infection occurred during the follow-up period. The ultrasonography examination showed that the Achilles tendon was healing. At last follow-up, according to Amer Lindholm evaluation standard, the results of ankle function was excellent in 26 cases and good in 6 cases. CONCLUSION: The treatment of acute closed Achilles tendon rupture with a posterior median longitudinal W-shaped incision combined with deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture is effective, which can fully exposed the incision, the quality of Achilles tendon anastomosis is reliable, and it can effectively avoid wound complications and iatrogenic injury of gastrocnemius nerve. 目的: 探讨跟腱后正中纵行 W 形切口联合逐层梳理缝合法治疗急性闭合性跟腱断裂的临床疗效。. 方法: 回顾分析 2015 年 8 月—2019 年 2 月收治且符合选择标准的 32 例急性闭合性跟腱断裂患者临床资料。男 25 例，女 7 例；年龄 21～48 岁，平均 33 岁。均为运动伤导致闭合性跟腱断裂。入院查体：均可扪及跟腱断裂间隙；Thompson 征阳性；术前 MRI 及超声检查证实跟腱断裂，断端距跟腱止点 2～8 cm，平均 3.5 cm。受伤至手术时间 1～10 d，平均 2.7 d。术中采用跟腱后正中纵行 W 形切口显露跟腱断端，并深浅双 Kessler 端端缝合+逐层梳理缝合跟腱，V-Y 推进缝合皮肤切口。观察术后并发症发生情况；复查跟腱超声观察跟腱腱性愈合情况；末次随访时采用 Arner Lindholm 评定标准评价踝关节功能。. 结果: 术后 32 例患者均获随访，随访时间 8～24 个月，平均 12 个月。手术切口均Ⅰ期愈合，未发生创缘皮肤坏死，切口不愈合、延迟愈合及感染、切口瘢痕增生或溃疡、腓肠神经损伤等并发症。随访期内无跟腱再断裂及深部感染等发生，复查跟腱超声提示跟腱均腱性愈合。末次随访时根据 Amer-Lindholm 评定标准评价踝关节功能，获优 26 例、良 6 例。. 结论: 跟腱后正中纵行 W 形切口联合深浅双 Kessler 端端缝合+逐层梳理缝合治疗急性闭合性跟腱断裂，术中暴露充分，跟腱吻合质量切实可靠，且能够有效避免切口并发症及医源性腓肠神经损伤等并发症，疗效良好。.

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