New technical procedure involving Achilles tendon rupture treatment through transcutaneous suture

摘要

The Achilles tendon is the widest tendon of the human body. Achilles tendon belongs to the extrasynovial tendons group and this allows it a faster recovery, thanks to local hematoma from the peritenon, necessary for the scarification. We concluded that in Achilles tendon rupture treatment it is essential to maintain the tendon covering skin integrity, the peritendinous integrity, to maintain the local hematoma formed during and after tendon rupture, reattaching the ruptured tendon heads and maintain them in this position by suturing them and by relaxing the sural triceps muscle. The percutaneous suture requires five pairs of mirror micro-incisions (5 mm) on one side and the other of the tendon. It is necessary for one of the pairs to be placed to the rupture level. With a surgical needle, we arm the proximal and distal heads of the tendon by different threads. By traction and muscular relaxation, we bring in contact the two ruptured heads and then we knot together the arming threads. The inferior member was cast immobilized in relaxing position for the sural triceps muscle for a 45 days period. Using this technique, we have operated 15 cases in our Clinic. In all the cases, we obtained a healing by first intention of the tegument micro-incisions. After the cast immobilization suppression, during 30 days the patients were in a recovery program. At the end of this program, they have recovered completely the dorsal and plantar flexion and the walking. In four months after the surgery, the esthetic of the area is completely restored, this technique being the only surgical technique that realizes this recovery.