Results of wound complications in Achilles tendon repair at a public service

Abstract

Objective: To evaluate wound healing outcomes and postoperative complications in patients undergoing surgical treatment of Achilles tendon rupture at a Brazilian university hospital operating exclusively through the public healthcare system and to identify factors associated with worse clinical outcomes. Methods: This retrospective observational study analyzed 64 adult patients with complete Achilles tendon ruptures who underwent surgical treatment between 2019 and 2024. All procedures were performed by orthopedic residents under supervision. Data collected included demographics, comorbidities (smoking, obesity, diabetes), surgical techniques, time to surgery, and wound-related complications. The primary outcome was postoperative complications. Secondary outcomes included time to complete wound healing, rerupture rates, and need for reoperation. Descriptive statistics and inferential analyses were performed with 5% significance (p < 0.05). Results: Mean patient age was 45 years, with 73% aged 40-60 years. Overall complication rate was 20.3%, primarily infection (15.6%) and wound dehiscence (12.5%). Nerve injury occurred in 7.8% and deep infection in 4.7%. No reruptures or tendon exposures were observed. Comorbidities significantly increased the risk of complications (OR ≈3.7, p < 0.05) and delayed healing. No significant associations were found between outcomes and patient age, time to surgery, or surgical technique. Conclusion: Surgical Achilles tendon repair by supervised residents yielded satisfactory outcomes with complication rates comparable to international literature. Comorbidities were the primary risk factors for adverse events, underscoring the need for preoperative optimization. This study validates the safety and effectiveness of the university hospital model when structured supervision and standardized protocols are implemented. Level of evidence III; Retrospective cohort study.