Advertisement

Anterior Ankle Incision Healing Complications With and Without Tourniquet Use: A Retrospective Comparative Cohort Study

Published:August 14, 2022DOI:https://doi.org/10.1053/j.jfas.2022.08.006

      Abstract

      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

      Keywords

      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
      Institutional Access: Sign in to ScienceDirect

      References

        • Conti SF
        • Wong YS.
        Complications of total ankle replacement.
        Clin Orthop Relat Res. 2001; 391: 105-114
        • Myerson MS
        • Mroczek K.
        Perioperative complications of total ankle arthroplasty.
        Foot Ankle Int. 2003; 24: 17-21
        • Haskell A
        • Mann RA.
        Perioperative complication rate of total ankle replacement is reduced by surgeon experience.
        Foot Ankle Int. 2004; 25: 283-289
        • Glazebrook MA
        • Arsenault K
        • Dunbar M.
        Evidence-based classification of complications in total ankle arthroplasty.
        Foot Ankle Int. 2009; 30: 945-949
        • Whalen JL
        • Spelsberg SC
        • Murray P.
        Wound breakdown after total ankle arthroplasty.
        Foot Ankle Int. 2010; 31: 301-305
        • Elliott AD
        • Roukis TS.
        Anterior incision offloading for primary and revision total ankle replacement: a comparative analysis of two techniques.
        Open Orthop. 2017; 11: 678-686
        • Reb CW
        • Watson BC
        • Fidler CM
        • Van Dyke B
        • Hyer CF
        • Berlet GC
        • Prissel MA.
        Anterior ankle incision wound complications between total ankle replacement and ankle arthrodesis: a matched cohort study.
        J Foot Ankle Surg. 2021; 60: 47-50
        • Attinger CE
        • Evans KK
        • Bulan E
        • Blume P
        • Cooper P.
        Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization.
        Plast Reconstr Surg. 2006; 117: 261S-293S
        • Raikin SM
        • Kane J
        • Ciminiello ME.
        Risk factors for incision-healing complications following total ankle arthroplasty.
        J Bone Joint Surg Am. 2010; 92: 2150-2155
        • DeCarbo WT
        • Hyer CF.
        Negative-pressure wound therapy applied to high-risk surgical incisions.
        J Foot Ankle Surg. 2010; 49: 299-300
        • Matsumoto T
        • Parekh SG.
        Use of negative pressure wound therapy on closed surgical incision after total ankle arthroplasty.
        Foot Ankle Int. 2015; 36: 787-794
        • Gross CE
        • Hamid KS
        • Green C
        • Easley ME
        • DeOrio JK
        • Nunley JA.
        Operative wound complications following total ankle arthroplasty.
        Foot Ankle Int. 2017; 38: 360-366
        • Lawton CD
        • Butler BA
        • Dekker 2nd, RG
        • Prescott A
        • Kadakia AR
        Total ankle arthroplasty versus ankle arthrodesis-a comparison of outcomes over the last decade.
        J Orthop Surg Res. 2017; 12: 76
        • Smith TO
        • Hing CB.
        The efficacy of the tourniquet in foot and ankle surgery? A systematic review and meta-analysis.
        Foot Ankle Surg. 2010; 16: 3-8
        • Meyr AJ
        • Mirmiran R
        • Naldo J
        • Sachs BD
        • Shibuya N.
        American College of Foot and Ankle Surgeons® Clinical Consensus statement: perioperative management.
        J Foot Ankle Surg. 2017; 56: 336-356
        • Wakai A
        • Winter DC
        • Street JT
        • Redmond PH.
        Pneumatic tourniquets in extremity surgery.
        J Am Acad Orthop Surg. 2001; 9: 345-351
        • Lin L
        • Li G
        • Li J
        • Meng L.
        Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study.
        BMC Anesthesiol. 2019; 19: 70
        • Konrad G
        • Markmiller M
        • Lenich A
        • Mayr E
        • Rüter A.
        Tourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures.
        Clin Orthop Relat Res. 2005; 433: 189-194
        • Kruse H
        • Christensen KP
        • Møller AM
        • Gögenur I.
        Tourniquet use during ankle surgery leads to increased postoperative opioid use.
        J Clin Anesth. 2015; 27: 380-384
        • Kukreja P
        • Lehtonen E
        • Pinto MC
        • Patel HA
        • McKissack HM
        • Shah A.
        Postoperative tourniquet pain in patients undergoing foot and ankle surgery.
        Cureus. 2018; 10: e3678
        • Præstegaard M
        • Beisvåg E
        • Erichsen JL
        • Brix M
        • Viberg B.
        Tourniquet use in lower limb fracture surgery: a systematic review and meta-analysis.
        Eur J Orthop Surg Traumatol. 2019; 29: 175-181
        • Silver R
        • de la Garza J
        • Rang M
        • Koreska J.
        Limb swelling after release of a tourniquet.
        Clin Orthop Relat Res. 1986; 206: 86-89
        • Benedick A
        • Rivera T
        • Vallier HA.
        Effect of tourniquet use during ankle fracture fixation on wound healing and infectious complications.
        Foot Ankle Int. 2020; 41: 714-720