Clinical patterns of scarring process in the Achilles tendon of pediatric patients

O.V. Filippova, A.V. Govorov, K.A. Afonichev, Ya.N. Proschenko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery, Pushkin

Aim: to study the characteristic patterns of the cicatricial process in Achilles tendon and ankle joint in pediatric patients.

Patients and Methods: clinical evaluation of scar tissue in the Achilles tendon was performed in 24 patients using the Vancouver scale. Besides, history data, patient complaints, and trophic disturbances in scar tissue were taken into account.

Results: the main causes of cicatricial deformities in the Achilles tendon are burns and mechanical injuries. The most common complaints are: scar tension when walking, scar trauma when wearing shoes, itching, especially in trophic disturbances. Analysis of anamnestic data showed that even after 2–5 years after the skin restoration, the quality of scar tissue in the Achilles tendon in 58.3% of cases corresponds to 10–13 points, which is regarded as the most unfavorable scar. The maximum number of points was noted for elasticity and scar thickness, which in 58.3% of cases exceeded 5 mm. In 41.6% of cases, trophic disturbances were detected on the scar tissue, which were represented by fissure, erosions and trophic ulcers with sluggish epithelization and common recurrence. Such ulcers do not tend to the self-healing since the resulting local inflammatory process contributes to the strengthening of fibrosis.

Conclusions: scar tissue formation in the Achilles tendon is prolonged with the marked tendency to hypertrophy; a significant functional and mechanical load on the segment against the background of the most unfavorable condition of scar tissue (10 or more points on the Vancouver scale) leads to the signs of recurrent trophic disturbances in the form of erosions and ulcers in 41.6% of cases. Children with scars in the Achilles tendon should be under regular medical supervision, especially during the period of intensive growth, since preventive and timely surgical treatment will allow preventing secondary shortening of the Achilles tendon and contracture occurrence in the ankle joint.

Keywords: scars, scar deformities, scar tissue, post-burn scars, Achilles tendon, Vancouver scale.

For citation: Filippova O.V., Govorov A.V., Afonichev K.A., Proschenko Ya.N. Clinical patterns of scarring process in the Achilles tendon of pediatric patients. RMJ. 2020;2:19–22.