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December 27, 1971

Treating the Damaged Achilles Tendon

Author Affiliations

San Francisco

JAMA. 1971;218(13):1945. doi:10.1001/jama.1971.03190260059026

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To the Editor.—  The QUESTIONS AND ANSWERS section of The Journal (218:103,1971) discussed treatment of a postoperative wound slough exposing the Achilles tendon. Pickrell's response is in accord with the conventional wisdom on this matter, in which I believed until a recent case caused me to revise my thinking.A 28-year-old man developed a suppurative ulceration, 7 cm in circumference, over the insertion of the Achilles tendon. Approximately the distal one-half inch of the tendon was destroyed and it was detached from its insertion. Measures were undertaken to clean the wound in preparation for a pedicle graft. Before this could be accomplished, the patient was charged with parole violation and spent two months in the county jail. Upon his release, he returned, and reconstitution of the Achilles tendon with granulations overlying the entire tendon had taken place. The wound was clean, and the ulceration which was at this time