Is Posterolateral Incision Better than Direct Posterior Incision in Chronic Tear of Achilles Tendon Reconstruction? A comparative Study of Series of Cases

Background. Wound gaping and dehiscence following open repair or reconstruction for chronic (more than 4 weeks old) Achilles tendon ruptures is a great concern and the subject of debate. The location of the incision is crucial. There is no consensus as to the safest incision location. This study aims to observe the effects of posterior midline and posterolateral surgical incision (modified skin incision) on wound dehiscence. Methods. It was hypothesized that using Posterolateral incision improves wound healing and minimizes chance of wound dehiscence. In our study, open reconstruction was performed for 172 active young soldiers with chronic Achilles tendon ruptures. We consider tear as chronic when it was older than 4 weeks duration and was untreated. Patients were divided into Group A (posterolateral) and group B (direct posterior approach) and TA tendon reconstruction was performed using the Bosworth technique. Patients were followed for two years for wound complication. We used the American Orthopedic Foot, Ankle Society (AOFAS) score, ankle-hind foot score, the Achilles tendon Total Rupture Score (ATRS), VAS for pain and functional evaluation using Heel rise height index (HRHI). Results. In our comparative study between 2 groups, in group B, 7 patients (11.6%) developed wound dehiscence whereas none in group A. We did not record any sural nerve injury, limitation with ankle motion, footwear related complication and skin adhesion in posterolateral incision group. The AOFAS score averaged 93.5 +/- 4 in posterolateral incision (group A) and 78.8 +/- 7 in direct posterior incision (group B). Three soldiers developed re-rupture following the fresh injury in group A. Conclusions. Based on our results, posterolateral skin incision gives equally good results as direct posterior incision however, this approach minimizes the risk of wound-related complication especially wound dehiscence following TA tendon reconstruction.