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Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note

Purpose: Nowadays, surgical treatment of acute avulsions of the Achilles tendon represents a hard challenge. There is often the possibility that the calcaneus remains completely uncovered from the tendon, making the reinsertion of its distal stub complex. At the same time, the standard open surgical...

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Autores principales: Longo, Umile Giuseppe, Candela, Vincenzo, Berton, Alessandra, Di Naro, Calogero, Stelitano, Giovanna, Maffulli, Nicola, Denaro, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766519/
https://www.ncbi.nlm.nih.gov/pubmed/33352626
http://dx.doi.org/10.3390/medicina56120715
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author Longo, Umile Giuseppe
Candela, Vincenzo
Berton, Alessandra
Di Naro, Calogero
Stelitano, Giovanna
Maffulli, Nicola
Denaro, Vincenzo
author_facet Longo, Umile Giuseppe
Candela, Vincenzo
Berton, Alessandra
Di Naro, Calogero
Stelitano, Giovanna
Maffulli, Nicola
Denaro, Vincenzo
author_sort Longo, Umile Giuseppe
collection PubMed
description Purpose: Nowadays, surgical treatment of acute avulsions of the Achilles tendon represents a hard challenge. There is often the possibility that the calcaneus remains completely uncovered from the tendon, making the reinsertion of its distal stub complex. At the same time, the standard open surgical technique could cause difficult wound healing because of the weak blood supply, the increasing possibility of rupture, and the bacterial contamination. To overcome these risks, less invasive procedures should be considered. Methods: We developed an innovative minimally invasive procedure for fixation of acute avulsions of the Achilles tendon employing an integration of four longitudinal stab incisions and one distal semicircular Cincinnati incision. In this way, the distal Achilles tendon stub and the calcaneal insertion are exhibited. Results: We basted the tendon through percutaneous sutures performed across the four stab incisions with a Mayo needle threaded with Ultrabraid. The procedure is repeated with another loop of Ultrabraid. After having bruised the calcaneus bone insertion of the tendon, two sites for two suture anchors were prepared using a specific hole preparation device for the anchors’ footprint. Finally, we placed two suture anchors to reinsert the tendon to the calcaneal insertion. Conclusion: Our new less invasive technique is a promising alternative optional procedure for the Achilles tendon (AT) avulsion repair allowing clear exposure of the Achilles tendon insertion, maintaining the longitudinal wholeness of the dermis, and minimizing possible associated complications.
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spelling pubmed-77665192020-12-28 Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note Longo, Umile Giuseppe Candela, Vincenzo Berton, Alessandra Di Naro, Calogero Stelitano, Giovanna Maffulli, Nicola Denaro, Vincenzo Medicina (Kaunas) Technical Note Purpose: Nowadays, surgical treatment of acute avulsions of the Achilles tendon represents a hard challenge. There is often the possibility that the calcaneus remains completely uncovered from the tendon, making the reinsertion of its distal stub complex. At the same time, the standard open surgical technique could cause difficult wound healing because of the weak blood supply, the increasing possibility of rupture, and the bacterial contamination. To overcome these risks, less invasive procedures should be considered. Methods: We developed an innovative minimally invasive procedure for fixation of acute avulsions of the Achilles tendon employing an integration of four longitudinal stab incisions and one distal semicircular Cincinnati incision. In this way, the distal Achilles tendon stub and the calcaneal insertion are exhibited. Results: We basted the tendon through percutaneous sutures performed across the four stab incisions with a Mayo needle threaded with Ultrabraid. The procedure is repeated with another loop of Ultrabraid. After having bruised the calcaneus bone insertion of the tendon, two sites for two suture anchors were prepared using a specific hole preparation device for the anchors’ footprint. Finally, we placed two suture anchors to reinsert the tendon to the calcaneal insertion. Conclusion: Our new less invasive technique is a promising alternative optional procedure for the Achilles tendon (AT) avulsion repair allowing clear exposure of the Achilles tendon insertion, maintaining the longitudinal wholeness of the dermis, and minimizing possible associated complications. MDPI 2020-12-19 /pmc/articles/PMC7766519/ /pubmed/33352626 http://dx.doi.org/10.3390/medicina56120715 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Technical Note
Longo, Umile Giuseppe
Candela, Vincenzo
Berton, Alessandra
Di Naro, Calogero
Stelitano, Giovanna
Maffulli, Nicola
Denaro, Vincenzo
Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note
title Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note
title_full Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note
title_fullStr Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note
title_full_unstemmed Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note
title_short Less Invasive Fixation of Acute Avulsions of the Achilles Tendon: A Technical Note
title_sort less invasive fixation of acute avulsions of the achilles tendon: a technical note
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766519/
https://www.ncbi.nlm.nih.gov/pubmed/33352626
http://dx.doi.org/10.3390/medicina56120715
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