Percutaneous Achilles Tendon Repair

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Radiographic templating

2

Execute surgical workthrough

  • describes the steps of the procedure to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • basic orthopedic set

2

Room setup and equipment

  • standard OR table
  • fluoroscopy

3

Patient positioning

  • place patient prone
  • place a thigh tourniquet
G

Skin Incisions

1

Make the first cut

  • make the first incision at the site of the rupture

2

Make the second cut

  • second incision 5 cm proximal to the first incision
  • make this incision over the medial half
  • this minimizes the risk of injury to the sural nerve

3

Make the third cut

  • third incision 5 cm distal to the rupture
H

Passage of the First Suture

1

Identify the tendon

  • use a small curved hemostat to define the track of the tendon

2

Suture the proximal end of the tendon

  • use a curved 90 mm cutting needle with number 1 nylon suture
  • pass a the needle through middle incision through the tendon substance and have it exit through the proximal incision
  • reintroduce the needle through the proximal incision
  • make sure that separate entry point is used
  • have the needle exit the middle incision

3

Suture the distal end of the tendon

  • introduce the needle through the middle incision
  • pass the needle through the distal stump of the tendon

4

Test the sutures

  • apply traction to the suture ends to ensure that good hold of both tendons is present
  • place an artery clip on the free ends of the suture
I

Passage of the Second Suture

1

Suture the proximal end of the tendon

  • use a curved 90 mm cutting needle with number 1 nylon suture
  • pass a the needle through middle incision through the tendon substance and have it exit through the proximal incision
  • reintroduce the needle through the proximal incision
  • make sure that separate entry point is used
  • have the needle exit the middle incision

2

Suture the distal end of the tendon

  • introduce the needle through the middle incision
  • pass the needle through the distal stump of the tendon

3

Test the sutures

  • apply traction to the suture ends to ensure that good hold of both tendons is present
  • place an artery clip on the free ends of the suture
J

Suture Tying

1

Tie the sutures

  • place the ankle in the plantar flexion
  • tie the sutures with the ankle in plantar flexion
K

Wound Closure

1

Close the wound

  • close the wound with nonabsorbale suture

2

Immobilize the ankle

  • place a cast with the ankle in plantar flexion
Postoperative Patient Care
 

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