Halil İbrahim BEKLER, TAHSİN BEYZA BEYZADEOĞLU, ALPER GÖKÇE, Erkan SERVET

Aşil tendonu tamirlerinde poliglaktinin yol açtığı aseptik akıntılar

Aşil tendonu yaralanmalarının cerrahi tedavisinde amaç tendonu yeniden sağlamlaştırmaktır. Bu amaçla çeşitli dikiş teknik ve malzemeleri kullanılabilir. Dikiş malzemesi çok ya da tek lifli, emilebilir veya emilemez olabilir. Bu yazıda, Aşil tendonunun cerrahi onarımından sonra süreğen akıntı gelişen dört olgu sunuldu. Bu olguların hepsinde kalın poliglaktin (Vicryl) kullanılmıştı. Olgulara, dikiş malzemelerini temizlemek için açık cerrahi girişim uygulandı. Hastalar sorunsuz iyileşti. Aşil tendonu onarımlarında gereğinden kalın dikiş malzemesi ve büyük düğüm kullanmaktan kaçınılmalıdır. Çok lifli emilebilir cerrahi iplikler de bakteri yerleşimine ve doku reddine yatkınlıkları nedeniyle ek sorun yaratabilirler.

Anahtar Kelimeler:

Tedavi sonucu, Debridman, Erişkin, Aşil tendon, Erkek, Drenaj, Tendon yaralanmaları, Dikiş teknikleri, Yara iyileşmesi, Süturlar, Yırtık

Aseptic drainage associated with polyglactine sutures used for repair of Achilles tendon ruptures

The aim of surgical treatment of Achilles tendon ruptures is to restore stability of the tendon. Various suture techniques and materials can be used for this purpose. Suture materials may be polyfilament or monofilament, absorbable or nonabsorbable. We presented four patients who developed severe chronic discharges associated with thick polyglactine (Vicryl) used during open repair of acute Achilles tendon ruptures. Surgical removal of suture materials and debridement resulted in complete improvement without any complications. The use of thick suture materials and large knots should be avoided in the repair of Achilles tendon ruptures. Polyfilament and absorbable sutures may pose problems due to their tendency to cause bacterial colonization and tissue rejection.

Keywords:

Treatment Outcome, Debridement, Adult, Achilles Tendon, Male, Drainage, Tendon Injuries, Suture Techniques, Wound Healing, Sutures, Rupture,

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1. Dalton GP, Wapner KL, Hecht PJ. Complications of achilles and posterior tibial tendon surgeries. Clin Orthop Relat Res 2001;(391):133-9.
2. Bhandari M, Guyatt GH, Siddiqui F, Morrow F, Busse J, Leighton RK, et al. Treatment of acute Achilles tendon ruptures: a systematic overview and metaanalysis. Clin Orthop Relat Res 2002;(400):190-200.
3. Gebauer M, Beil FT, Beckmann J, Sarvary AM, Ueblacker P, Ruecker AH, et al. Mechanical evaluation of different techniques for Achilles tendon repair. Arch Orthop Trauma Surg 2007;127:795-9.
4. Lewis N, Quitkin HM. Strength analysis and comparison of the Teno Fix Tendon Repair System with the two-strand modified Kessler repair in the Achilles tendon. Foot Ankle Int 2003;24:857-60.
5. Benthien RA, Aronow MS, Doran-Diaz V, Sullivan RJ, Naujoks R, Adams DJ. Cyclic loading of Achilles tendon repairs: a comparison of polyester and polyblend suture. Foot Ankle Int 2006;27:512-8.
6. Yildirim Y, Saygi B, Kara H, Cabukoglu C, Esemenli T. Tendon holding capacities of the suture materials used in repairing Achilles tendon rupture. [Article in Turkish] Acta Orthop Traumatol Turc 2006;40:164-8.
7. Yel M, Memik R, Arazi M, Ogun TC. Akut asil tendon rüptürlerinin cerrahi tedavi sonuçları. Acta Orthop Traumatol Turc 1999;33:313-6.
8. Gabrielli F, Potenza C, Puddu P, Sera F, Masini C, Abeni D. Suture materials and other factors associated with tissue reactivity, infection, and wound dehiscence among plastic surgery outpatients. Plast Reconstr Surg 2001;107:38-45.
9. Gammelgaard N, Jensen J. Wound complications after closure of abdominal incisions with Dexon or Vicryl. A randomized double-blind study. Acta Chir Scand 1983;149:505-8.
10. Van Winkle W Jr, Hastings JC, Barker E, Hines D, Nichols W. Effect of suture materials on healing skin wounds. Surg Gynecol Obstet 1975;140:7-12.
11. Merritt K, Hitchins VM, Neale AR. Tissue colonization from implantable biomaterials with low numbers of bacteria. J Biomed Mater Res 1999;44:261-5.