Anterior ankle incisions and tourniquet use in foot and ankle surgery have both been associated with increased incidence of incisional healing complications. Although a tourniquet is commonly used for procedures such as total ankle replacement and ankle arthrodesis that utilize an anterior ankle incision, it is possible to avoid tourniquet use while preserving adequate visualization with atraumatic layered dissection and closure, appropriate use of electrocautery, and ligation of vessels as needed. The primary aim of this study is to report rates of anterior ankle incisional healing complications both with and without tourniquet use. A retrospective chart review was performed on consecutive patients undergoing total ankle replacement or ankle arthrodesis through a multi-provider foot and ankle surgery practice between 2013 and 2018. A total of 121 patients, 58 (47.9%) in the tourniquet group and 63 (52.1%) in the no-tourniquet group, were included in this study with a median follow-up period of 36 (range 2-96) months. There was a higher rate of incisional healing complications for the tourniquet group (5.2%) compared to the no-tourniquet group (3.2%), however this did not reach statistical significance (p = .670). There was no significant difference in operative time between the tourniquet and no-tourniquet group (p = .405). The overall incisional healing complication rate was 4.1%. Although avoiding tourniquet use alone does not appear to significantly reduce anterior ankle incisional healing complications, the described technique has yielded an overall lower rate of incisional complications compared to those commonly reported in the literature.
Level of Clinical Evidence
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to The Journal of Foot and Ankle Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Complications of total ankle replacement.Clin Orthop Relat Res. 2001; 391: 105-114
- Perioperative complications of total ankle arthroplasty.Foot Ankle Int. 2003; 24: 17-21
- Perioperative complication rate of total ankle replacement is reduced by surgeon experience.Foot Ankle Int. 2004; 25: 283-289
- Evidence-based classification of complications in total ankle arthroplasty.Foot Ankle Int. 2009; 30: 945-949
- Wound breakdown after total ankle arthroplasty.Foot Ankle Int. 2010; 31: 301-305
- Anterior incision offloading for primary and revision total ankle replacement: a comparative analysis of two techniques.Open Orthop. 2017; 11: 678-686
- Anterior ankle incision wound complications between total ankle replacement and ankle arthrodesis: a matched cohort study.J Foot Ankle Surg. 2021; 60: 47-50
- Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization.Plast Reconstr Surg. 2006; 117: 261S-293S
- Risk factors for incision-healing complications following total ankle arthroplasty.J Bone Joint Surg Am. 2010; 92: 2150-2155
- Negative-pressure wound therapy applied to high-risk surgical incisions.J Foot Ankle Surg. 2010; 49: 299-300
- Use of negative pressure wound therapy on closed surgical incision after total ankle arthroplasty.Foot Ankle Int. 2015; 36: 787-794
- Operative wound complications following total ankle arthroplasty.Foot Ankle Int. 2017; 38: 360-366
- Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade.J Orthop Surg Res. 2017; 12: 76
- The efficacy of the tourniquet in foot and ankle surgery? A systematic review and meta-analysis.Foot Ankle Surg. 2010; 16: 3-8
- American College of Foot and Ankle Surgeons® Clinical Consensus statement: perioperative management.J Foot Ankle Surg. 2017; 56: 336-356
- Pneumatic tourniquets in extremity surgery.J Am Acad Orthop Surg. 2001; 9: 345-351
- Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study.BMC Anesthesiol. 2019; 19: 70
- Tourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures.Clin Orthop Relat Res. 2005; 433: 189-194
- Tourniquet use during ankle surgery leads to increased postoperative opioid use.J Clin Anesth. 2015; 27: 380-384
- Postoperative tourniquet pain in patients undergoing foot and ankle surgery.Cureus. 2018; 10: e3678
- Tourniquet use in lower limb fracture surgery: a systematic review and meta-analysis.Eur J Orthop Surg Traumatol. 2019; 29: 175-181
- Limb swelling after release of a tourniquet.Clin Orthop Relat Res. 1986; 206: 86-89
- Effect of tourniquet use during ankle fracture fixation on wound healing and infectious complications.Foot Ankle Int. 2020; 41: 714-720
Published online: August 14, 2022
Conflicts of Interest: Dr. Blacklidge is a consultant for Paragon28, Novastep, Extremity Medical; Dr. Miller is a consultant for Flower Orthopedics; Dr. Elliott is a consultant for Stryker and DJO.
Financial Disclosure: None reported.
© 2022 by the American College of Foot and Ankle Surgeons. All rights reserved.