Minimally invasive ultrasound guided surgery for extracting stitches as a cause of secondary infections after tendoraphy of the Achilles tendon rupture

Abstract

Cilj: Prikazati mogućnosti korištenja ultrazvuka u rješavanju kasnih komplikacija nakon kirurškog zbrinjavanja rupturirane Ahilove tetive. Prikaz slučaja: U radu su prikazana dva bolesnika kod kojih se nakon šest i pet godina na mjestu kirurške intervencije zbog rupture Ahilove tetive razvio upalni proces uz formiranje apscesa. Ultrazvučnim pregledom se u oba bolesnika dijagnosticira postojanje apscesa i stranog tijela u smislu zaostalog konca. Pod kontrolom ultrazvuka u operacijskoj dvorani minimalno invazivnim kirurškim pristupom izvade se svi zaostali konci i drenira formirani apsces. Rasprava: Klasični kirurški zahvat je invazivan s mogućnošću propagacije infekcije prema zdravom tkivu te uz mogućnost pogreške u smislu nenalaženja svih zaostalih konaca uzročnika upalnog odgovora. Prikazom ovih dvaju slučajeva dokazali smo da, osim u dijagnostičke svrhe, ultrazvuk može poslužiti kao pomoć pri samom kirurškom postupku u cilju izvođenja minimalno invazivnog kirurškog zahvata. Zaključak: U prikazu slučaja upućuje se na potencijalnu vrijednost minimalno invazivne kirurške tehnike pod kontrolom ultrazvuka kojom se mogu izvaditi zaostali konci i drenirati nastali apsces u bolesnika.Aim: To evaluate the use of ultrasound in management of the long term complications after surgical procedure of the ruptured Achiles tendon. Case report: Authors report two cases of patients who developed tissue inflammation and abscess six and five years after surgery following rupture of the Achilles tendon. Ultrasound examination of the Achilles tendon confirmed abscess and foreign body (stitch) in both patients. A minimally invasive ultrasound guided technique was used for extracting all stitches and drainage of the present abscess in both patients. Discussion: The clasical surgical approach is an invasive procedure with high possibility of widespreading infection into the healthy tissue. There is also the possibility of not finding all stitches which cause inflammation. These two cases emphasize the use of ultrasound not only for diagnosis but also as a help, during the minimally invasive surgical procedure. Conclusion: In this case report we point out the potential value of the minimally invasive ultrasound guided surgery for extracting stitches and drainage of the present abscesses in both patients