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

Abstract

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.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.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.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.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.