Achilles tendon reconstruction using microsurgery helps women escape the risk of disability

A seemingly simple knife wound to the heel has left a 49-year-old woman at risk of permanently losing her ability to walk due to severe infection and gangrene.

Thanks to advanced microsurgical techniques, doctors have almost completely recreated the Achilles tendon - an important part that determines mobility - helping patients hopefully regain 80-90% of their walking ability.

Initially, the patient's wound was only sutured at a local medical facility without detecting the ruptured Achilles tendon. When the patient's ability to walk did not improve, the patient was diagnosed with a ruptured tendon and underwent tendon repair surgery at another facility.

However, after surgery, the wound developed an abscess, severe necrosis and infection, requiring a second surgery to clean it. However, the condition remained serious: the wound did not heal, continuously oozed fluid, the entire Achilles tendon was 10-12cm long and necrotic, the soft tissue around the heel was destroyed, causing the patient to almost completely lose the ability to move.

Dr. Duong Manh Chien, a plastic surgeon at the Central Hospital for Tropical Diseases, said: "In the face of a complex injury with deep infection, loss of both tendons and skin, we had to intervene in two stages. In the first stage, we cut and cleaned the necrotic tissue, cleaned the abscess, and used a negative pressure suction system (VAC) to control the infection. After the tissue was clean, the team performed a microsurgical technique called 'flap cluster' - taking a flap of tissue from the thigh area consisting of two separate parts: tendon and skin on the same blood supply pedicle and then connecting it to the vascular system at the heel."

The special feature of the surgery is the use of tendon from the tensor fascia femoris muscle - a thick, strong tendon with suitable elasticity and load-bearing capacity - to reconstruct the Achilles tendon. This tendon is rolled up, shaped like the original tendon and attached to the heel bone.

At the same time, a vascularized skin flap is transferred to cover the large skin defect. Both flaps are nourished by microvascular anastomosis under a modern microscope, with magnification up to 40 times, ensuring precise manipulation of capillaries smaller than a hair.

Dr. Duong Manh Chien emphasized: “This is the first time that the Central Hospital for Tropical Diseases has performed simultaneous reconstruction of tendons and vascularized skin using the 'flap' microsurgery technique in the context of severe infection. Very few facilities in Vietnam currently have the capacity to perform this technique."

The modern microsurgical microscope system plays a key role, increasing the image magnification from 4.5 times (normal magnifying glass) to 40 times, allowing detailed observation of capillaries, minimizing the risk of vascular occlusion or graft necrosis. The surgery not only requires advanced microsurgical techniques but is also a complex problem: infection control, differentiation between living and necrotic tissue, and selection of replacement materials with high biomechanical similarity.

After surgery, the patient was able to almost completely recover walking function - which depends largely on the Achilles tendon, which bears the main force when walking.

From this case, Dr. Duong Manh Chien, MD, recommends: “Tendon and soft tissue injuries need to be carefully evaluated from the beginning. Suturing the skin while leaving out the tendon can lead to serious loss of function. Post-operative sterile control is also vital to avoid infection and necrosis. If the Achilles tendon has become necrotic, it needs to be taken to a facility with specialized plastic surgery capabilities for reconstruction and rehabilitation."

People need to go to specialized medical facilities immediately when the wound does not heal or shows signs of discharge, swelling, or pain.

In cases of complex injuries like the above, only centers with microsurgery expertise and modern equipment are capable of handling them effectively, helping patients preserve motor function and quality of life./.

(TTXVN/Vietnam+)

Source: https://www.vietnamplus.vn/tai-tao-gan-got-bang-ky-thuat-vi-phau-giup-nguoi-phu-nu-thoat-nguy-co-tan-phe-post1073013.vnp