Management of a Chronic Achilles Tendon Infection with Achilles Tendon Resection & Fish Skin Application

Introduction: Wound healing complications in patients that underwent an Achilles tendon surgery is associated with postoperative morbidity. These complications following Achilles tendon surgery are due to the fragility and limited vascularization of the skin. The rate of infection is estimated to be around 0.2-3.6% (Fourniols 2012). This rate increases in patients over 60 years old, tobacco use, corticosteroid therapy, diabetes, and surgery delayed more than 7 days.Methods:Patient is a 76 year old female that presented as a second opinion following surgery for a primary repair following an Achilles tendon rupture after a fall. After the surgery, the incision dehisced and she had an infected, exposed Achilles tendon. She underwent revisional surgery a month later.  She presented to our clinic 3 weeks later on Augmentin and Levaquin. Patient had local wound care which displayed no improvement.IResults:nitial culture grew Bacteroides fragilis and Enterobacter cloacae. MRI report showed re-tear of the distal Achilles insertion with 5cm gap with proximal retraction of the tendon. Surgery included removing the remaining infected tendon, bone biopsy of the calcaneus, and insertion of abx beads. She returned to the OR 2 weeks later for removal of abx beads, partial closure of surgical wound, with Application of a fish skin graft to skin and soft tissue deficits. The wound was healed after two applications of fish skin graft and 3 months after the first revisional surgery.Discussion: Achilles tendon wound dehiscence can be difficult to treat due to lack of soft tissue and vascular supply. This is a successful case of healing an infected Achilles tendon with tendon resection and application of fish skin graft.References: