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Wound Complications from Surgeries Pertaining to the Achilles Tendon

An Analysis of 219 Surgeries

Amol Saxena Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA.

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Nicola Maffulli Department of Trauma and Orthopaedic Surgery, Keele University, Stoke-on-Trent, Staffordshire, England.

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Aidan Nguyen Fellow, Sports Medicine/Foot and Ankle Surgery, Palo Alto Medical Foundation, Palo Alto, CA.

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Albert Li Fellow, Sports Medicine/Foot and Ankle Surgery, Palo Alto Medical Foundation, Palo Alto, CA.

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Background: A retrospective review of one surgeon’s practice was conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/bursectomy, and management of calcific tendinopathy of the Achilles tendon.

Methods: We evaluated the incidence of infection and other wound complications, such as suture reactions, scar revision, hematoma, incisional neuromas, and granuloma formation.

Results: A total of 219 surgical cases were available for review (140 males and 70 females; mean ± SD age at the time of surgery, 46.5 ± 12.6 years; age range, 16–75 years). Seven patients experienced a wound infection, three had keloid formation, six had suture granulomas, and six had suture abscesses, for a total complication rate of 10.0%. Six patients had more than one complication; therefore, the percentage of patients with complications was 7.3%. There were no hematomas. Seven patients had additional surgery after their wound complications; some had simple granuloma excision, and one necessitated a flap. Patients with risk factors such as diabetes mellitus, smoking, and rheumatoid arthritis necessitating corticosteroid therapy were more likely to have a wound complication (Fisher exact test, P = .03).

Conclusions: Complications with Achilles tendon surgery may be unavoidable. Suture granulomas may appear in a delayed manner. Absorbable and nonabsorbable sutures can be implicated. (J Am Podiatr Med Assoc 98(2): 95–101, 2008)

Corresponding author: Amol Saxena, DPM, Department of Sports Medicine, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301. (E-mail: HeySax@aol.com)