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Open repair of achilles tendon rupture
Open repair of acute Achilles tendon ruptures remains the gold standard of operative treatment, especially for athletic individuals, because of the historically low rate of reruptures, high rate of return to sports, and decreased complication rates with newer techniques. Advocates of open repair argue that Achilles tendon injuries often result in complex obliquely oriented tears that cannot be adequately apposed and repaired with percutaneous of mini-invasive techniques.
Open repair of achilles tendon rupture—Krackow et al.
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With the patient prone, make a posteromedial incision approximately 10 cm long, about 1 cm medial to the tendon, and ending proximal to where the shoe counter strikes the heel.
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Sharply dissect through the skin, subcutaneous tissues, and tendon sheath. Reflect the tendon sheath with the subcutaneous tissue to minimize subcutaneous dissection.
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Approximate the ruptured ends of the tendon with a 2-0 nonabsorbable suture ( Fig. 16.1 ).
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Check the repair for stability after the sutures are tied.
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Close the peritenon and subcutaneous tissues with 4-0 absorbable sutures.
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Close the skin and apply a sterile dressing and a posterior splint or short-leg cast with the foot in gravity equinus.
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