Jahir Hussain, K (2013) A retrospective study to analyse the functional outcome of various procedures to treat tendo achilles injuries. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: The achilles tendon plays a crucial role in the bipedal human beings. Injury to achilles tendon causes great difficulty in walking and running. In our people acute injuries to achilles tendon with open wounds in TA region is more common unlike the west where chronic ruptures and sport injuries are more common. This is because most Indians use Indian toilets which are a common cause of open injuries to achilles tendon[closet injuries]. Also most of us do not wear shoes hence the TA region is not protected at work place. TA region is a poorly vascularised area which may cause problems in healing. When the patients present early the management is fairly straightforward. However if the patient is not managed well in the first chance then they may develop complications like skin necrosis over TA region and rerupture of the tendon .then patient has to undergo more extensive procedures. Hence this study was undertaken to evaluate the cause, the course, management and functional outcome of injuries to tendo achilles. AIM OF THE STUDY: 1. To study the various causes of tendo achilles injuries. 2. To analyse the functional outcome of various methods of repair done for tendo achilles injuries. MATERIALS AND METHODS: This is a retrospective study of 25 patients with tendo achilles injuries who presented to our department between august 2010 to January 2013. Patients of all age groups and both sexes were included. Patients with open wounds with Achilles tendon injuries, closed rupture of achilles tendon and patients who were treated outside and developed complications like re ruptures were all included in the study. All the patients were subjected to x ray foot and ankle to rule out bony injury. Diagnosis of tendo Achilles was made clinically and confirmed intra operatively. Ultrasound or MRI was not required for establishing diagnosis in any of these patients. All the patients in whom the cut ends of the Achilles tendon could be brought together underwent suturing of the cut ends of tendon. The patients with totally cut tendon were managed with Bunnell sutures. The patients with partial rupture were managed with modified Kessler sutures. The patients in whom the two cut ends could not be brought together were managed by reconstruction of Achilles tendon using various procedures like fascia lata graft, turn down flap, plantaris or peroneus brevis flap. Postoperatively the limb was immobilised with the foot in plantar flexion for 8 weeks. At the end of 8 weeks the cast was discarded and gradual weight bearing and mobilisation started. CONCLUSION: The following conclusions are derived from this study 1. Tendo acilles injuries are more common in males possibly because more of them get injured at work place. 2. Open injuries to Achilles tendon is the usual presentation unlike the west because of our habit of using Indian toilet and our habit of not wearing shoes. 3. First chance is the best chance to treat tendo Achilles injuries. Primary surgical management if done well produces the best functional outcome. 4. If patient develops complications due to mismanagement in the first instance, further management needs more extensive procedures and the complication rates are also higher 5. In complex defects in TA region single stage reconstruction with free flap and tendon graft gives good functional outcome. 6. Rehabilitation following surgery with adequate immobilisation and effective physiotherapy is very important for good functional outcome.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg. No. 18102052 |
| Uncontrolled Keywords: | tendo achilles injuries ; functional outcome ;s procedures ; retrospective study. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 15 Jun 2018 02:24 |
| Last Modified: | 15 Jun 2018 02:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8494 |
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