Review Question - QID 4396

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.

Incorrect Answers:
Answers 1, 3, 4, 5: Repair of a re-ruptured Achilles tendon is not advised in the setting of an active infection.