Exposed necrotic tendons

Abstract

Tendon necrosis may be observed in several types of wounds, traumas or chronic wounds like pressure ulcers, diabetic foot ulcers or arterial leg ulcers, as a consequence of skin necrosis. The origin is multifactorial, exposure to air and desiccation of poorly vascularised structures being the most frequently encountered situation and infection and degloving being also observed. The deep parts of the tendons often remain vascularised enough to be appropriately debrided and covered either with a negative pressure therapy or directly using a dermal substitute and skin grafting. Flaps are sometimes preferred, but direct skin grafting is not recommended as it leads to adherences. Immobilisation of the tendon is the key element to prevent infection to spread along the tendon sheets and develop tunnels and allow covering structures to heal. Tendon necrosis should be considered as an emergency in order to preserve the functional results.