Biswajit Mishra, Rajendra Prasad Das, Annada Prasad Pattnaik
BACKGROUND: Tendoachillis injuries in western patients are mainly due to sports injury. Where as in our country it is mainly due to injury in lavatory pan, road traffic accidents and direct cut injury. Pattern of injury varies and so also the method of reconstruction. We here represent a prospective study of various type of tendoachillis injury, different methods of reconstruction, associated complications and functional outcome. MATERIAL AND METHOD: A prospective study was done in M.K.C.G hospital Berhampur, Orissa from July 2013 to January 2015. A Total of 30 patients of tendoachillis injuries were included in our study. Patients were classified in to different groups depending upon nature of tendoachillis injury i.e. with or without skin loss, with or without segmental loss of tendoachillis, number of skin laceration (Single or multiple) and with or without avulsion fracture of calcaneum. Most of the patients without skin loss were treated in emergency department and all the patients with skin loss and with segmental loss of tendon were admitted to the hospital. Patients with simple laceration of tendoachillis were by repaired by prolene 1-0 and stainless steel wire. Patients with segmental loss of tendoachillis were repaired with proximal segment of tendon which was reversed upside down 180 degrees (Bosworth Technique). Skin loss were managed with peroneal perforator based distal fasciocutaneous flap, islanded reverse sural flap and cross leg flap as indicated in particular patients. All the patients were managed as per the same post-operative protocol. Patients were followed up from a minimum of 6 month to 2 year. Early and late complications were observed. RESULT: In patients without skin loss most common complications were prolene granuloma and sinus mainly related to material used for repair i.e. prolene. In patients with skin loss complications were related to flaps used for reconstruction like partial flap loss, total flap loss, flap dehiscence, infection, seroma, marginal skin necrosis. All the patients regained normal range of plantar flexion and dorsi flexion. CONCLUSION: TA tendon injury with segmental loss of tendon associated skin loss can effectively be managed by proper selection of reconstructive methods to give good functional results.
