Abstract
Posterior crural fasciotomy (PF) may reduce postoperative surgical site infection
(SSI) rate compared to inserted vacuum suction drainage (VD) in open Achilles tendon
repair surgery. Thus, we aimed to compare the postoperative SSI rate between PF and
VD in open Achilles's tendon repair surgery. A prospective, single-centered, nonrandomized
controlled study of consecutive adult patients undergoing primary open Achilles tendon
repair was performed at tertiary referral hospital between January 2017 and January
2020. Patients received either PF or VD from 2 experienced surgeons. Data were collected
on demographic, clinical, and intraoperative characteristics along with postoperative
SSI and other outcomes. The primary outcome was SSI rate. Secondary outcomes were
Achilles tendon total rupture score, functional foot index, and visual analogue scale.
A total of 60 patients were eligible and included in the final analysis (PF group
n = 30 and VD group n = 30). Two (6.7%) patients in the PF group and 5 (16.7%) patients
in the VD group experience postoperative SSI (crude risk ratio 0.40; 95% confidence
interval 0.08, 1.90; p = .228). In inverse-probability-treatment-weighted propensity score analysis, the
PF group had a significantly lower SSI rate than the VD group (adjusted risk ratio
0.30; 95% confidence interval 0.01, 0.91; p = .033). Inverse-probability-treatment-weighted propensity score analysis of Achilles
tendon total rupture score along with crude analysis of total functional foot index
and visual analogue scale were also significantly better in the PF group than the
VD group (all p < .05). PF during open Achilles repair was associated with a significant reduction
in postoperative SSI infection rate compared to VD.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Achilles tendon disorders: etiology and epidemiology.Foot Ankle Clin. 2005; 10: 255
- Acute rupture of the Achilles tendon.Foot Ankle Clin. 2005; 10: 331
- The role of recreational sport activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases.Am J Sports Med. 1989; 17: 338
- Operative versus nonoperative treatment of acute Achilles tendon ruptures: a multicenter randomized trial using accelerated functional rehabilitation.J Bone Joint Surg Am. 2010; 92: 2767
- Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials.J Bone Joint Surg Am. 2012; 94: 2136
- Surgical versus non-surgical methods for acute Achilles tendon rupture: a meta-analysis of randomized controlled trials.J Foot Ankle Surg. 2018; 57: 1191
- A prospective randomized trial comparing surgical and nonsurgical treatments of acute Achilles tendon ruptures.Am J Sports Med. 2016; 44: 2406
- Rerupture and deep infection following treatment of total Achilles tendon rupture.J Bone Joint Surg Am. 2002; 84: 2016
- Surgical treatment of reruptures of the tendoachilles following nonsurgical treatment.Clin Orthop Relat Res. 1979; 140: 175-177
- Reconstruction of skin and tendon defects from wound complications after Achilles tendon rupture.J Foot Ankle Surg. 2001; 40: 158
- Radial forearm flap plus flexor carpi radialis tendon in Achilles tendon reconstruction: surgical technique, functional results, and gait analysis.Microsurgery. 2015; 35: 608
- Using a posterior compartment fasciotomy and paratenon closure in acute Achilles tendon repair.Orthopedics. 2016; 39: e790
- Surgical strategies: acute Achilles rupture-open repair.Foot Ankle Int. 2008; 29: 114
- Achilles tendon ruptures.Instr Course Lect. 1999; 48: 219
- Achilles tendon ruptures. A new method of repair, early range of motion, and functional rehabilitation.Am J Sports Med. 1995; 23: 392
- Achilles tendon open repair augmented with distal turndown tendon flap and posterior crural fasciotomy.J Foot Ankle Surg. 2016; 55: 1180
- Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis.Plast Reconstr Surg. 2013; 132: 443
- Closed suction surgical wound drainage after hip fracture surgery: a systematic review and meta-analysis of randomised controlled trials.Int Orthop. 2008; 32: 723
- Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017.JAMA Surg. 2017; 152: 784
- Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee.Am J Infect Control. 1999; 27: 97
- The Achilles tendon total rupture score (ATRS): development and validation.Am J Sports Med. 2007; 35: 421
- Validity and reliability of the Achilles tendon total rupture score.J Foot Ankle Surg. 2013; 52: 736
- The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures.Health Qual Life Outcomes. 2012; 10: 24
- A review of the foot function index and the foot function index - revised.J Foot Ankle Res. 2013; 6: 5
- Thai version of the foot function index: a cross-cultural adaptation with reliability and validity evaluation.BMC Sports Sci Med Rehabil. 2020; 12: 56
- Foot function index: a promising questionnaire for individuals with Charcot-Marie-Tooth disease type 1A.Arch Phys Med Rehabil. 2019; 100: 2403
- Responsiveness and validity of the SF-36, Ankle osteoarthritis scale, AOFAS ankle hindfoot score, and foot function index in end stage ankle arthritis.Foot Ankle Int. 2012; 33: 57
- Responsiveness of the foot function index, AOFAS clinical rating systems, and SF-36 after foot and ankle surgery.Foot Ankle Int. 2006; 27: 930
- Reliability of the foot function index: a report of the AOFAS outcomes committee.Foot Ankle Int. 2006; 27: 867
- Evaluation of the validity of the foot function index in measuring outcomes in patients with foot and ankle disorders.Foot Ankle Int. 2006; 27: 38
- The foot function index: a measure of foot pain and disability.J Clin Epidemiol. 1991; 44: 561
- Reliability and validity of the Finnish version of the visual analogue scale foot and ankle (VAS-FA).Foot Ankle Surg. 2018; 24: 474
- Minimal important change for the visual analogue scale foot and ankle (VAS-FA).Foot Ankle Surg. 2021; 27: 196
- Normative data of the visual analogue scale foot and ankle (VAS FA) for pathological conditions.Foot Ankle Surg. 2011; 17: 166
- Management of acute Achilles tendon ruptures: a review.Bone Joint Res. 2018; 7: 561
- A simple technique for the retention of a subcuticular suture.Surgeon. 2003; 1: 149
- Method for securing a subcuticular suture with minimal buried knot.Plast Reconstr Surg. 1998; 102: 2447
- A new technique to secure an entirely buried subcuticular suture.Plast Reconstr Surg. 1995; 95: 423
- An introduction to propensity score methods for reducing the effects of confounding in observational studies.Multivariate Behav Res. 2011; 46: 399
- Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies.Stat Med. 2015; 34: 3661
- Matching on the estimated propensity score.Econometrica. 2016; 84: 781
- Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: a meta-analysis.Int J Surg. 2017; 40: 178
- The role of the paratenon in Achilles tendon healing: a study in rats.Am J Sports Med. 2018; 46: 1214
- Statistical power in parallel group point exposure studies with time-to-event outcomes: an empirical comparison of the performance of randomized controlled trials and the inverse probability of treatment weighting (IPTW) approach.BMC Med Res Methodol. 2015; 15: 87
- Evaluation of the propensity score methods for estimating marginal odds ratios in case of small sample size.BMC Med Res Methodol. 2012; 12: 70
Article info
Publication history
Published online: June 30, 2022
Footnotes
Financial Disclosure: There was no source of funding for this research.
Conflict of Interest: There were no competing interests for this research.
Identification
Copyright
© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.
