In the setting of a deep infection and a re-ruptured achilles tendon, initial management consists of extensive debridement and irrigation with no attempt at reconstruction followed by culture-specific IV antibiotics for 6 weeks.
Deep infection following achilles tendon repair is a rare but devastating complication. In the setting of a deep infection, the first step should be a thorough irrigation and debridement with excision of any necrotic or infected tendon. Culture-specific antibiotics are administered for a duration of 6 weeks. Once this has been completed, issues such as soft tissue coverage and reconstruction of the re-reptured achilles tendon may be entertained.
Pajala et al. review 409 patients that were treated surgically for an acute achilles tendon rupture. 23 cases of re-rupture and 9 cases of deep infection were noted. Deep infections were treated with debridement and antibiotics, followed by soft tissue coverage at a later date.
Bruggeman et al retrospectively reviewed 167 operative open achilles tendon repairs and determined that risk factors for wound problems included tobacco use, diabetes, and steroid use.
Figure A shows a clinical image of a deep infection following achilles tendon repair. Illustration V shows the ultrasonic appearance of a ruptured Achilles tendon.
Answers 1, 3, 4, 5: Repair of a re-ruptured achilles tendon is not advised in the setting of an active infection.
Coughlin MJ, Schon LC. Disorders of tendons. In: Coughlin MJ, Mann RA, Saltzman CL,eds. Surgery of the Foot and Ankle. 8th ed. St Louis, MO: Mosby Elsevier; 2007:1149-1275.
Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002 Nov;84-A(11):2016-21.
PMID:12429764 (Link to Abstract)
Bruggeman NB, Turner NS, Dahm DL, Voll AE, Hoskin TL, Jacofsky DJ, Haidukewych GJ. Wound complications after open Achilles tendon repair: an analysis of risk factors. Clin Orthop Relat Res. 2004 Oct;(427):63-6.
PMID:15552138 (Link to Abstract)