Achilles Tendon Repair

WHAT YOU SHOULD KNOW:

• Achilles (ah-KIL-ez) tendon (TEN-don) repair is surgery to fix your damaged Achilles tendon. Tendons connect muscles to bones, and together with muscles, work to move your arms, legs, fingers, feet, and toes. The Achilles tendon is located at the ankle, and connects the calf muscle to heel bone. Achilles tendon repair is done to reattach a ruptured (completely torn) Achilles tendon. This may be done using an open or a mini-open surgery. In a mini-open surgery, a special device is used without making a large incision (cut) in the ankle area. A complete tendon rupture may be acute or chronic based on the duration of time from injury. Injuries that occurred within three weeks are considered as acute, and after three weeks they are chronic. Chronic injuries can only be repaired using the open surgery.
  
  
• During surgery, caregivers repair the injured Achilles tendon by sewing the ruptured ends together. A tendon or fascia (hard tissue) graft may be used to strengthen the repair. The graft may be man-made, taken from another part of your body, or from a donor. It is used mostly in chronic tendon injuries. After surgery you may need a splint or cast to protect the tendon and help it heal. You may need to do special exercises to help build the strength back in your ankles. With repair of the Achilles tendon, your regular ankle and foot movements may be returned, and normal activities restored.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You could get an infection or bleed too much. You could have trouble breathing or get blood clots. Other parts around the tendon, such as blood vessels and nerves may also be affected. Sometimes, even after surgery, the ankle may not go back to the way it was before. If you do not have surgery, the pain and problems you have when moving your ankle or foot may worsen. You may have problems walking, and may have trouble going back to your usual activities, including sports. Call your caregiver if you are worried or have questions about your injury, treatment, or care.

WHILE YOU ARE HERE:

Before surgery:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• Monitoring:
  
  
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
    
    
  • Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Anesthesia: This is medicine to make you comfortable during surgery. Caregivers work with you to decide which anesthesia is best and whether you will be awake or completely asleep.

During surgery:

• You will be placed on your stomach with your feet hanging at the end of the table. A rubber cuff called a tourniquet is put around your leg. This slows down the blood flow to the ankle and helps decrease blood loss. Your caregiver cleans your leg, ankle, and foot with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean.
  
  
• For open surgery, caregivers make a long incision on your ankle. The joint is checked and the torn ends are identified. Blood clots are washed off and torn edges of the tendon are cut out. Caregivers sew the ends of the torn tendon back together. A graft may be placed to strengthen the repair. Caregivers may also cut a strip of the calf fascia, twist, and turn it down over the repair. The incisions are closed with stitches and wrapped with a bandage.
  
  
• For a mini-open surgery, caregivers feel your ankle to look for the gap made by the missing tendon. A small incision is made in this area. A device shaped like a letter 'w' is inserted into the incision. This device is adjusted to fit the tendon properly and hold the tendon ends. Once in place, stitches (threads) are passed through the sides and left inside. The stitches are passed in three areas, with extra thread left on both ends of the torn tendon. The stitches are then tied in pairs, and the incisions are closed with stitches and wrapped with a bandage. With both surgeries, a cast or splint is put on your ankle so it can heal faster.

After surgery: You are taken to a room where you can rest. Caregivers will check on you. When they see that you are ready, you may also be allowed to go home. If you are staying in the hospital, you will be taken to your hospital room. Do not get out of bed until your caregiver says it is OK. A bandage is used to cover your stitches or staples. This bandage keeps the area clean and dry to help prevent infection. A caregiver may remove the bandage soon after your procedure or surgery to check the area.

• Medicines: Your caregiver may give you the following kinds of medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Medicines for pain, swelling, or fever: You may be given medicines to treat pain, swelling, or fever while you are in the hospital. These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease, a history of bleeding in your stomach, or any other medical problems. Also tell your caregiver about any allergies you have to medicines. Tell your caregiver about all other medicines, herbs, and supplements that you have taken lately.
  
  
• Physical therapy: A physical therapist helps you with special exercises. These exercises help make your bones and muscles stronger.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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