Wound Complications from surgeries pertaining to the Achilles tendon: an analysis of 219 patients onclusion A Saxena, *N Maffulli, A Nguyen, A Li,

Dept. of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA USA

Dept. of Orthopaedics & Traumatololgy, Keele Univ., Stoke-on-Trent, UK esults 

The Achilles tendon is commonly operated on, but has associated wound complications, ranging from 7-14% in previously reported series larger than 100 cases. These series have been reported by European authors. Most common complications include dehiscence, infection, hypertrophic scars, nerve entrapment and granulomas. Smokers and those with diabetes are reported to have higher rate of complications.  

To study the incidence of one surgeonís (based in the USA) complications associated with Achilles tendon surgery and see if the wound complication rate differs from previous authors. 

Retrospective review of one USA based surgeonís practice was conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/ bursectomy, and management of calcific tendinopathy of the Achilles tendon.

Incidence of infection, and wound complications such as suture reactions, scar revision, hematoma, incisional neuromas and granuloma formation. No tourniquet was used in all cases, and type of suture was noted. 

219 surgical cases were available for review (140 males, 70 females; average age at the time of surgery: 46.5 Ī 12.6 years, range 16-75). Seven patients experienced a wound infection (3.2%), three had keloid formation, six had suture 

granulomas, and six had suture abscesses, with an overall complication rate of 22 of 219 surgeries (10.1%).

Seven patients had additional surgery following their wound complications; some had simple granuloma excision, while one necessitated a flap. There were no hematomas. Delayed granulomas occurred in six patients (2.7%), mostly associated with non-absorbable polyester suture (P=.34), and all became clinically evident more than six months after the index procedure.

There was no association with procedure and increased likelihood of a wound complication (P=.79). Patients with risk factors such as diabetes, smoking and Rheumatoid arthritis necessitating steroids were more likely to have a wound complication, (P=.03). 

Complications with Achilles tendon surgery may be unavoidable. Suture granulomas may appear in a delayed fashion, in some cases, six months post-operatively. Absorbable and non-absorbable suture can both be implicated in suture reactions and granulomas. The overall incidence in wound complications appears similar in this series conducted in the USA, with those reported in Europe. 


Bruggeman N, Turner N, Dahm D, Voll A, Hoskin T, Jacofsky D, Haidukewych G. Wound complications after open Achilles tendon repair: an analysis of risk factors. Clin Orthop Rel Res 427: 63-6, 2004

Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U: Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. 21(6):791-9, 1993

Movin, Ryberg, McBride, Maffulli: Acute rupture of the Achilles tendon. 
Foot Ankle Clin. 2005 Jun;10(2):331-56.

Nelen, G., Martens, M, Burssens, A. Surgical treatment of chronic Achilles tendonitis. Am J Sports Med; 17(6): 754-759,  1989

Paavola M, Orava S, Leppilahti J, Kannus P, Jarvinen M: Chronic Achilles tendon overuse injury: complications after surgical treatment. An analysis of 432 consecutive patients. Am J Sports Med. 28(1):77-82, 2000

Williams JGP: Achilles tendon lesions in sport. Sports Med. 3(2):114-135, 1986

Wong, Barrass & Maffulli : Quantitative review of operative and non-operative management of Achilles tendon ruptures. 
Am J Sports Med. 2002 Jul-Aug;30(4):565-75.

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