Wound Complications After Primary Open Achilles Tendon Repair Meghan Bishop, M.D. Carly Comer, B.S. Justin Kane, M.D. Steven M. Raikin, M.D.

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1 Wound Complications After Primary Open Achilles Tendon Repair Meghan Bishop, M.D. Carly Comer, B.S. Justin Kane, M.D. Steven M. Raikin, M.D. Foot and Ankle Service Rothman Institute Hospital Philadelphia, PA

2 Disclosures Wound Complications After Primary Open Achilles Tendon Repair Meghan Bishop, MD My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 Introduction Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures Operative repair is generally favored with respect to re-rupture rates but comes with the risk of wound healing complications 1

4 Introduction Wound complications reported to be anywhere from 7-13% 2-3 Caution should be taken while reviewing these data as many of the studies represent a heterogeneous patient population and fail to define what they classified as a wound complication

5 Purpose We hypothesize that clinically significant wound complications defined as those extending the treatment of the patient longer than the usual post-operative course; those requiring surgical intervention; or those requiring antibiotics would be significantly less than that reported in the literature.

6 Methods Between August 2000 and May 2014, all acute Achilles tendon ruptures treated with direct end-to-end repair by the senior author (S.M.R.) were identified Patient demographics, operative notes, and pre and post-operative office notes were retrospectively reviewed

7 Methods Wound complications were identified and defined as either none, minor requiring no acute interventions, minor requiring prolonged postoperative care, and major requiring a return to the operating room Definition of Wound Healing Complications None (n=336): Complete healing with no wound complications Minor without prolonged treatment (n=22): skin edge necrosis, suture granuloma Minor with prolonged treatment (n=9): Additional office visits, in-office debridement, oral/topical antibiotics Major (n=2): Formal operative intervention for any wound complication Statistical analysis was completed comparing wound complications in our cohort to that reported in the literature

8 Results A total of 369 consecutive acute Achilles tendon ruptures treated with direct end-toend repair were identified Average age 41 years (20-74) 314 males, 55 females Average BMI 27.9 ( ) Major wound complication

9 A total of 33 (8.94%) wound complications were identified No statistical significance was found compared to the rates reported in the literature Results However, when the rates of complications were compared looking at wound complications that were considered clinically significant, there was a Wound Complications Complication Rate* p-value 95% CI All 8.94% complications (33/369) Minor without prolonged treatment Minor with prolonged treatment Major 5.96% (22/369) % (9/369) < % (2/369) < *Rate of complications were compared to that reported in the literature using the binomial test statistically significant lower complication rate (Major- 0.54%, Minor with prolonged treatment- 2.44%)

10 Results No independent variables could be identified that were predictive of wound complications. Patient Demographics Demographic Number p-value Age (Years) 41.1 (20-74) 0.85 Gender M-314 ; F ( ) 0.65 BMI Tobacco Yes-34 ; No Diabetes Yes-6 ; No Steroids Yes-1 ; No Time To Surgery (Days) 8.9 (1-60) 0.21 Tourniquet Time (Minutes) 33.0 (0-59) 0.87 *Multivariate Logistic Regression Analysis was utilized to predict statistically Rothman significant Institute patient of Orthopaedics factors at associated with wound Thomas healing Jefferson complications University

11 Conclusions This large single surgeon series shows that while our overall wound complication rate of 8.94% may be similar to prior studies, the majority of the complications were minor and did not negatively impact patient outcome Only 0.54% of wound complications required surgical debridement and 2.44% required additional outpatient wound management, suggesting significant wound complications following primary Achilles tendon repair are not as prevalent as previously described

12 References 1. Jones MP, Riaz JKK, Smith RLC. Surgical interventions for treating acute Achilles tendon rupture: Key findings from a recent Cochrane review. J Bone Joint Surg Am. 2012;94(e88): Bruggeman NB, Turner NS, Dahm DL, et al. Wound complications after open Achilles tendon repair: An analysis of risk factors. Clin Orthop. 2004;427: Saxena A, Maffulli N, Nguyen A, et al. Wound complications from surgeries pertaining to the Achilles tendon: an analysis of 219 surgeries. J Am Podiatr Med Assoc. 2008;98(2):