Incidence of Wounds Associated with Posterior Midline Incision for Achilles Tendon Pathology in a Large Cohort at a Tertiary Care Center.

Background: We sought to determine the wound complications associated with a straight midline incision overlying the Achilles tendon. Data on sex, age, body mass index (BMI), surgery performed, date of surgery, and wound development were collected.

Methods: We retrospectively collected data on 217 patients with a mean ± SD age of 46.16 ± 13.72 years and follow-up of 9.1 ± 12.42 months. The specific procedures performed with this incision included repair of ruptured Achilles tendon (n = 89), Haglund deformity correction (n = 75), and flexor hallucis longus tendon transfer (n = 63). Wound complication was defined as a delay in wound healing with necrosis of the incisional margins resulting in exposure of superficial or deep layers. Deep infection was defined as the need for intravenous antibiotics.

Results: We reported 15 wound complications (6.91%): ten (4.6%) were superficial and five (2.3%) were deep. All five patients with deep wound complications required operative debridement, and four patients required intravenous antibiotics. The infection rate of the midline incisional approach was 1.83%. Superficial wound complications were treated with local care and oral antibiotics, as necessary. There were no significant differences between age (P = .5986; P < .05), BMI (P = .7968; P < .05), smoking history (P = .6356; P < .05), or length of follow-up (P = .8338; P < .05). The overall wound rate of 6.91% is comparable with other literature with larger cohorts.

Conclusions: These results will help us better educate surgeons about the risk of wound development with the posterior midline Achilles tendon incision.