Comprehensive wound healing approach for exposed achilles tendon without paratenon by utilizing matriderm with vacuum-assisted closure (VAC) and second-stage skin grafting

---

Original Article

Author Details : Sudhir Singh*

Volume : 10, Issue : 3, Year : 2024

Article Page : 281-286

https://doi.org/10.18231/j.ijced.2024.050

Suggest article by email

Get Permission

---

Abstract

Introduction: Achilles tendon lesions often necessitate flap surgery for wound closure, particularly when the paratenon is absent, as skin grafts fail without a vascular bed. While fasciocutaneous flaps offer functional benefits, they are complex and aesthetically unappealing. This study explores a simpler method combining Matriderm, Vacuum-Assisted Closure (VAC) therapy, and skin grafting to enhance healing, reduce scarring, and improve outcomes for exposed Achilles tendons.
Aim: The study aims to optimize wound healing, minimize complications, and facilitate functional recovery of exposed Achilles tendons through a multi-step intervention involving Matriderm, VAC therapy, and skin grafting.
Materials and Methods: An 87-year-old female with a gangrenous, infected wound over her left lower limb, including an exposed Achilles tendon, underwent debridement and antibiotic treatment. Due to her frail condition, a simpler method was chosen over traditional flap surgery.
Intervention Steps: 1. Longitudinal Splitting: The Achilles tendon was split longitudinally to promote granulation tissue formation; 2. Matriderm Application: Matriderm, a bovine collagen matrix, provided a scaffold for cell ingrowth and neovascularization; 3. VAC Therapy: Subatmospheric pressure (-125 mmHg) was applied to remove excess fluid, reduce edema, and enhance blood flow, aiding granulation tissue formation; 4. Monitoring: Continuous monitoring ensured optimal granulation tissue development for successful skin grafting; 5.  Second-Stage Skin Grafting: A thin skin graft was applied to the vascularized bed and stabilized with skin staplers; 6. Wound Closure and Rehabilitation: Post-grafting, the wound was dressed and monitored until complete healing, with follow-up evaluations.
Results: Preliminary results indicated successful wound closure, minimal complications, and optimized healing. At a one-year follow-up, the skin was pliable, elastic, free from scarring or contracture, and aesthetically appealing.
Conclusion: We present a comprehensive very simple approach for wound cover healing of exposed bare Achilles tendon lacking paratenon by using MatriDerm with Vacuum-Assisted Closure (VAC) followed by a second-stage skin grafting procedure. The process involves sequential steps focusing on optimal wound healing, reduction of complications, and restoration of Achilles tendon functionality without the need of microsurgical skill or simple flap surgery with its own donor nonaesthetic morbidity.


Keywords: Achilles tendon, MatriDerm, Vacuum-Assisted Closure (VAC) therapy, Second-stage skin grafting, Exposed tendons, Wound healing, Longitudinal splitting of tendo achilles, Dermal substitute

How to cite : Singh S, Comprehensive wound healing approach for exposed achilles tendon without paratenon by utilizing matriderm with vacuum-assisted closure (VAC) and second-stage skin grafting. IP Indian J Clin Exp Dermatol 2024;10(3):281-286

This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.