Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

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A Study of Wound Healing in 402 Calcaneus Fracture Cases Using Precise Extensive L-Shaped Incision

10.21203/rs.3.rs-428542/v1 ◽

2021 ◽

Author(s):

Fushan Hou ◽

Xiao Liang ◽

Kun Xi ◽

Feng Zhao ◽

Bin Wang ◽

...

Keyword(s):

Wound Healing ◽

Internal Fixation ◽

Skin Necrosis ◽

Wound Complications ◽

Postoperative Wound ◽

Calcaneus Fracture ◽

Heel Bone ◽

Dressing Change ◽

Medical University ◽

Would Healing

Abstract Background: To investigate wound healing in 402 calcaneus fracture cases using precise extensive L-shaped incision.Method: We retrospectively analyzed 402 calcaneus fracture cases, involving patients who underwent heel bone reduction and internal fixation, using precise extensive L-shaped incision, at the second hospital of Shanxi medical university between January 2018 and December 2020. Postoperative would healing was evaluated using a self-designed skin margin grading system. Results: The patients experienced osseous healing after the surgery. A Maryland foot score of ≥90% was considered excellent. The skin margins from Grade I, II, III injuries healed spontaneously after dressing change. However, Grade IV injuries healed after debridement or removal of internal fixation.Conclusions: The precise extensive L-shaped incision, used in this study, allowed for fewer postoperative wound complications and lower incidence of skin necrosis.

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Comparison of 2-Octyl Cyanoacrylate Topical Skin Adhesive and Simple Interrupted Nylon Sutures for Wound Closure in Ankle Fracture Surgery

Foot & Ankle International ◽

10.1177/1071100718786166 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1283-1289

Author(s):

Young Hwan Park ◽

Jong Hyub Song ◽

Gi Won Choi ◽

Hak Jun Kim

Keyword(s):

Patient Satisfaction ◽

Ankle Fracture ◽

Statistical Power ◽

Wound Closure ◽

Operative Time ◽

Wound Complications ◽

Complication Rates ◽

Level Of Evidence ◽

Retrospective Comparative Study ◽

Fracture Surgery

Background: Multiple options are available for closure of incisions in ankle fracture surgery. The aim of our study was to compare postoperative outcomes between conventional simple interrupted nylon sutures and 2-octyl cyanoacrylate as a topical skin adhesive to close the incision after ankle fracture surgery. Methods: We retrospectively reviewed the records of 367 consecutive patients (174 simple interrupted nylon suture patients and 193 topical skin adhesive patients) who underwent operative treatment for ankle fracture between 2010 and 2015. Development of wound complications, operative time, Olerud–Molander Ankle Score (OMAS), and patient satisfaction with the wound were compared. The demographics between the 2 groups were not different. Results: There were no differences in complication rates ( P = .861), OMAS at 3 months or 12 months following surgery ( P = .897 and .646, respectively) between the 2 types of wound closure. Operative time was 9 minutes shorter when topical skin adhesive was used compared to nylon sutures ( P = .003). Patient satisfaction with their wound was significantly higher in the topical skin adhesive group than the nylon skin suture group ( P = .012). Conclusions: The use of 2-octyl cyanoacrylate topical skin adhesive for wound closure following ankle fracture surgery was effective, safe, and showed higher patient satisfaction compared to simple interrupted nylon sutures. Although caution should be taken because of the insufficient statistical power of complications, this method was an additional safe option for wound closure in ankle fracture surgery. Level of Evidence: Level III, retrospective comparative study.

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Local Infiltration Analgesia with Ropivacaine Improves Postoperative Pain Control in Ankle Fracture Patients: A Retrospective Cohort Study

Pain Research and Management ◽

10.1155/2020/8542849 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Bao-Liang Li ◽

Xizhe Liu ◽

Lihua Cui ◽

Wenqian Zhang ◽

Hui Pang ◽

...

Keyword(s):

Postoperative Pain ◽

Ankle Fracture ◽

Retrospective Cohort ◽

Wound Complications ◽

Local Infiltration Analgesia ◽

Local Infiltration ◽

Superficial Wound ◽

Vas Scores ◽

Fracture Surgery ◽

Infiltration Analgesia

Purpose. The study aimed at investigating the effect of local infiltration analgesia (LIA) with ropivacaine on postoperative analgesia for patients undergoing ankle fracture surgery. Methods. Consecutive patients were retrospectively included and analysed according to their medical records from July 2014 to August 2018 in a tertiary hospital. Inclusion criteria were patients undergoing open reduction and internal fixation (ORIF) for ankle fractures under general anaesthesia. Moreover, patients should have received intravenous patient-controlled analgesia (iPCA) or LIA + iPCA for postoperative pain relief. The primary outcome indicator was visual analogue scale (VAS) from 8 hours to 48 hours after surgery. Secondary outcomes included postoperative opioid requirement, need for rescue medication, opioid-related adverse effects, and wound complications. Results. In total, 89 consecutive patients were included in the study. There were 48 males and 41 females. The average age was 44.6 ± 7.0 years, and VAS scores were significantly lower in the LIA + iPCA group at 8 hours after surgery (1.51 ± 0.58 cm vs 4.77 ± 1.83 cm, p<0.001). The time to first tramadol consumption was longer (580 ± 60.9 minutes vs 281 ± 86.4 minutes, p<0.001), and the number of patients who need tramadol was lower in the LIA + iPCA group (18 vs 26, p=0.04). There was a statistically significant reduction in morphine consumption (25.1 ± 6.3 mg vs 73.4 ± 8.2 mg, p<0.001) and opioid-related side effects in the LIA + iPCA group (4 vs 10, p=0.023). No major wound complications were noted in either group. However, there were 2 cases with superficial wound necrosis in group LIA + iPCA and 3 patients with superficial wound necrosis in group iPCA, and all cured by local wound care. Conclusions. The retrospective cohort study indicates that LIA with ropivacaine can provide better early postoperative pain management with a reduction of VAS scores for ankle fracture surgery. Patients receiving wound infiltration also experience decreased opioid consumption, a lower rate of analgesia-related side effects, and comparable wound complication rate.

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Risk Factors for Wound Complications After Ankle Fracture Surgery

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.k.01088 ◽

2012 ◽

Vol 94 (22) ◽

pp. 2047-2052 ◽

Cited By ~ 121

Author(s):

Adam G Miller ◽

Andrew Margules ◽

Steven M Raikin

Keyword(s):

Risk Factors ◽

Ankle Fracture ◽

Wound Complications ◽

Fracture Surgery

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Closed-incision negative-pressure wound management in surgery—literature review and recommendations

European Surgery ◽

10.1007/s10353-020-00657-w ◽

2020 ◽

Vol 52 (6) ◽

pp. 249-267

Author(s):

Maria A. Smolle ◽

Sebastian P. Nischwitz ◽

Martin Hutan ◽

Primoz Trunk ◽

David Lumenta ◽

...

Keyword(s):

Wound Healing ◽

Cardiac Surgery ◽

Literature Review ◽

General Surgery ◽

Negative Pressure ◽

Wound Complications ◽

Postoperative Wound ◽

Positive Effects ◽

Pubmed Database ◽

Tensile Forces

Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

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Economic Burden of Inpatient Admission of Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100717709576 ◽

2017 ◽

Vol 38 (9) ◽

pp. 997-1004 ◽

Cited By ~ 14

Author(s):

Justin D. Stull ◽

Suneel B. Bhat ◽

Justin M. Kane ◽

Steven M. Raikin

Keyword(s):

Ankle Fracture ◽

Operative Management ◽

The United States ◽

Inpatient Admission ◽

Lateral Malleolus ◽

Ankle Fractures ◽

Outpatient Basis ◽

Medicare Reimbursement ◽

Trimalleolar Fractures ◽

Fracture Surgery

Background: Ankle fractures are among the most prevalent traumatic orthopaedic injuries. A large proportion of patients sustaining operative ankle fractures are admitted directly from the emergency department prior to operative management. In the authors’ experience, however, many closed ankle injuries may be safely and effectively managed on an outpatient basis. The aim of this study was to characterize the economic impact of routine inpatient admission of ankle fractures. Methods: A retrospective review of all outpatient ankle fracture surgery performed by a single foot and ankle fellowship–trained surgeon at a tertiary level academic center in 2012 was conducted to identify any patients requiring postoperative inpatient admission. The National Inpatient Sample was queried for operative management of lateral malleolus, bimalleolar, and trimalleolar ankle fractures in 2012 with regard to national estimates of total volume and length of stay by age. The maximum allowable Medicare inpatient facility reimbursements for diagnosis related group 494 and Medicare outpatient facility reimbursements for Current Procedural Terminology codes 27792, 27814, and 27822 were obtained from the Medicare Acute Inpatient Prospective Pricer and the Medicare Outpatient Pricer Code, respectively. Private facility reimbursement rates were estimated at 139% of inpatient Medicare reimbursement and 280% of outpatient reimbursement, as described in the literature. Surgeon and anesthesiologist fees were considered similar between both inpatient and outpatient groups. A unique stochastic decision-tree model was derived from probabilities and associated costs and evaluated using modified Monte Carlo simulation. Results: Of 76 lateral malleolar, bimalleolar, and trimalleolar ankle fracture open reduction internal fixation cases performed in 2012 by the senior author, 9 patients required admission for polytrauma, medical comorbidities, or age. All 67 outpatients were discharged home the day of surgery. In the 2012 national cohort analyzed, 48,044 estimated inpatient admissions occurred postoperatively for closed ankle fractures. The median length of stay was 3 days for each admission and was associated with an estimated facility reimbursement ranging from $12,920 for Medicare reimbursement of lateral malleolus fractures to $18,613 for private reimbursement of trimalleolar fractures. Outpatient facility reimbursements per case were estimated at $4,125 for Medicare patients and $11,459 for private insurance patients. Nationally, annual inpatient admissions accounted for $796,033,050 in reimbursements, while outpatient surgery would have been associated with $419,327,612 for treatment of these same ankle fractures. Conclusion: In the authors’ experience, closed lateral malleolus, bimalleolar, and trimalleolar fractures were safely and effectively treated on an outpatient basis. Routine perioperative admission of patients sustaining ankle fractures likely results in more than $367 million of excess facility reimbursements annually in the United States. Even if a 25% necessary admission rate were assumed, routine inpatient admission of ankle fractures would result in a $282 million excess economic burden annually in the United States. Although in certain cases, inpatient admission may be necessary, with value-based decision making becoming increasingly the responsibility of the orthopaedic surgeon, understanding the implications of inpatient stays for ankle fracture surgery can ultimately result in cost savings to the US health care system and patients individually. Level of Evidence: Level III, comparative series.

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Use of Intraoperative Tranexamic Acid and Wound Complications in Spine Surgery: A Retrospective Cohort Study

Asian Spine Journal ◽

10.31616/asj.2019.0235 ◽

2020 ◽

Vol 14 (5) ◽

pp. 639-646 ◽

Cited By ~ 1

Author(s):

Moti Kramer ◽

Michael Drexler ◽

Amir Herman ◽

Tal Kalimian ◽

Yuri Klassov ◽

...

Keyword(s):

Wound Healing ◽

Tranexamic Acid ◽

Spine Surgery ◽

Retrospective Cohort ◽

Wound Dehiscence ◽

Multivariate Regression Analysis ◽

Wound Complications ◽

Factors Affecting ◽

Postoperative Wound ◽

Academic Center

Study Design: A retrospective cohort study.Purpose: This study aims to examine the effect of tranexamic acid (TXA) on postoperative wound healing in spine surgery.Overview of Literature: TXA (Cyklokapron, Hexakapron) is a widely used anti-fibrinolytic drug that is shown to be effective in mitigating hemorrhage during and after surgery by competitively blocking plasminogen in fibrinolytic cascade. Plasminogen also plays a role in inflammatory and infectious diseases. The modulation of this role by TXA may influence the development of postoperative infectious complications.Methods: We collected and reviewed the charts of 110 patients who underwent spine surgery at our academic center. We used multivariate regression analysis to assess the factors affecting surgical site infection (SSI).Results: Of the 110 patients included in this study, 21 patients (19%) were categorized as having postoperative wound complications, 16 patients (14%) had deep or superficial wound infection, and five patients (4%) had wound dehiscence. Patients with a higher surgical invasiveness index score, longer surgeries, and older patients were found to be at risk for wound complications. TXA was determined not to be a direct risk factor for wound healing complications and SSIs.Conclusions: We found no risk of wound healing complications and SSI directly attributable to preoperative and intraoperative treatment with TXA in spine surgeries.

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Prophylaxis of surgical site infection

Kazan medical journal ◽

10.17816/kmj2020-852 ◽

2020 ◽

Vol 101 (6) ◽

pp. 852-858

Author(s):

A G Izmaylov ◽

S V Dobrokvashin ◽

D E Volkov ◽

L E Nikitina ◽

D I Tereshenkov ◽

...

Keyword(s):

Postoperative Complications ◽

Surgical Site Infection ◽

Infectious Complications ◽

Wound Complications ◽

Contamination Rate ◽

Site Infection ◽

Surgical Interventions ◽

Postoperative Wound ◽

Clean Contaminated

The article provides a literature review of the methods for the prevention of local infectious complications preoperative, intraoperative and postoperative. The analysis of the literature is devoted to the methods of prevention of postoperative purulent inflammatory wound complications. The review of scientific medical literature is based on the analysis of this problem. The article presents risk factors that contribute to the development of postoperative wound complications. Classification of surgical wounds was adopted to determine the risk of developing a surgical site infection (SSI), which distinguishes 4 classes: clean, conditionally clean, contaminated and dirty. The presented classification is based on the postoperative assessment of the wound bacterial contamination rate. The ClavienDindo classification of postoperative complications is the most relevant. This classification presents the tactics of the surgeon, depending on the class. The results of various studies indicate that antibiotic prophylaxis in the preoperative period reduces the development of local complications. The description of prevention methods focuses on intraoperative methods (devices for bringing together the edges of the wound, devices for treating wounds, surgical needles, suture material) and various types of antiseptics, which can reduce tissue damage during surgical interventions, reduce microbial contamination and the number of wound postoperative complications. Intraoperative instrumental methods allow less pronounced trauma to the wound during its processing and suturing. The postoperative method for diagnosing wound complications is an ultrasound method, which determines various formations in a postoperative wound.

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Preoperative Ankle Swelling and the Effect on Postoperative Wound Complications Following Ankle Fracture Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00113 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0011

Author(s):

Anthony Silva ◽

Simon Platt

Keyword(s):

Soft Tissue ◽

Ankle Fracture ◽

Operative Time ◽

Operative Intervention ◽

Ankle Fractures ◽

Wound Complications ◽

Soft Tissue Management ◽

Time To Surgery ◽

Soft Tissue Problems ◽

Fracture Surgery

Category: Trauma Introduction/Purpose: It is widely perceived that swelling in the first 24-48 hours following an ankle fracture precludes fixation, delaying operative treatment by 10-14 days to allow swelling to reduce. Such soft tissue management is assumed to be associated with better immediate soft tissue outcomes (wound closure) and mitigation of medium to long-term soft tissue problems. The aim of this study is to identify whether pre-operative ankle swelling has an independent effect on post-operative wound complications following ankle fracture surgery. The hypothesis of this study is that operative intervention at any point in time after the fracture of the ankle, irrespective of swelling, will show no better or worse soft tissue outcomes than those fixations delayed for swelling. The primary outcome measure will be wound complication. Methods: This is a prospective cohort study of patients presenting to a tertiary referral centre that were operatively managed for malleolar ankle fractures. Skeletally mature patients with closed, isolated ankle fractures were included in the study. Patients who were multiply-injured, had open fractures, and/or had known pre-existing limb oedema were excluded. Time to surgery was determined by the on-call attending orthopaedic surgeon. Ankle swelling of both the operative and non-operative limb was measured using the validated ‘Figure-of-eight’ measurement around the foot and ankle to quantify swelling of the affected ankle. A ratio of the patient’s 2 ankles was used as the measure of swelling to eliminate any bias between operators and standardise measurements between patients. Visual assessment of swelling was also recorded. Follow up was at 2, 6, and 12 weeks. Wound complications, patient co-morbidities, operative time, surgeon experience, and hospital stay duration were recorded Results: A total of 50 patients met inclusion criteria. Demographics were a 69% female predominance, a mean age of 45, and age range of 17- 69 years. A complication rate of 4% (n=2) was identified with both complications being superficial wound infections requiring oral antibiotics and wound episodes for treatment. Time to surgery had a mean of 6 days (range 0- 20). There was no significant difference in ankle swelling or time to surgery between patients with wound complications and those without. There were no significant differences identified between these groups when considering BMI, smoking status, diabetes, or peripheral vascular disease. Level of operating surgeon, operative time, tourniquet time, and closure material were also not significantly different between patients with and without wound complications. Conclusion: Our results show little post-operative soft tissue complications. If anything, our results are consistent with or show fewer soft tissue problems than the reported literature, despite a range of time to intervention. While we acknowledge that there may be a bias between surgeons in their preference in soft tissue management; we perceive that our study was sufficiently pragmatic to level this effect. Pre-operative swelling and time to operative intervention in ankle fracture surgery were not shown to correlate with change in soft tissue outcomes following ankle fracture surgery.

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Preoperative Depression is Associated With Increased Complications Following Ankle Fracture Surgery

Foot & Ankle Specialist ◽

10.1177/19386400211065967 ◽

2022 ◽

pp. 193864002110659

Author(s):

Matthew S. Broggi ◽

Syed Tahmid ◽

John Hurt ◽

Rishin J. Kadakia ◽

Jason T. Bariteau ◽

...

Keyword(s):

Ankle Fracture ◽

Pain Syndrome ◽

International Classification Of Diseases ◽

Emergency Department Visits ◽

Wound Complications ◽

Level Of Evidence ◽

Chi Squared ◽

Classification Of Diseases ◽

Icd Codes ◽

Fracture Surgery

Background The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. Results In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). Conclusion Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. Level of Evidence: 3

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