Wound Complications Associated with Achilles Tendon Repair

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: Acute rupture of the Achilles tendon is one of the most common tendon ruptures in the adult population, with an incidence between 5 to 10 per 100,000 people. Despite the relatively common occurrence of these injuries, best treatment practices are still heavily debated. Classically, a high rate of wound complications is a reason cited for avoiding open Achilles tendon repair. However, few large-scale studies exist to support this claim. Rates of wound complication are variable in the literature, with superficial wound infections reported anywhere from 7-10% and deep infections from 2-4%. The purpose of this current study was to report the incidence rate of wound complications after an acute Achilles tendon repair. Methods: A retrospective chart review at a single institution was performed to analyze the rate of wound complications in open and minimally invasive surgery (MIS) repair of acute Achilles tendon ruptures from January 2014 to December 2023. Wounds were categorized into no wound complication, wound complication requiring non-surgical management (superficial), and wound complication requiring reoperation (deep). We also collected patient demographics, risk factors such as smoking status, diabetes, BMI, and time to surgery; as well as surgical repair technique, repair suture used, use of flexor hallucis longus (FHL) or graft, and skin closure technique. Results: 1665 patients [1311 (87%) males] with 1692 Achilles were evaluated for wound complications. The average age was 43.5 (9.1-85.9) years old. The overall wound complication rate was found to be 3.3% (56 patients, 56 Achilles) with 1.8% having superficial infections, and 1.5% with deep infections. Patients with superficial infection were treated with antibiotics and resolved within 3 months. Deep infections required 25 irrigation and debridement surgeries. The average time to re-operation was 2.9 months. Of the 56 patients with infection, 53 were open repairs and 3 were MIS procedures. Conclusion: The data from this large case series demonstrates wound complications associated with repair of acute Achilles tendon ruptures are lower than previously reported.