scholarly journals Review of Use of Amniotic Membrane Allograft in Total Ankle Replacements

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0022
Author(s):  
Andrew Horn ◽  
Jeremy Saller ◽  
Daniel Cuttica ◽  
Steven Neufeld
Keyword(s):  
Soft Tissue ◽  
Amniotic Membrane ◽  
Wound Dehiscence ◽  
Extensor Tendon ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Split Thickness Skin Graft ◽  
Medical Comorbidities ◽  
Extensor Tendons ◽  
Ankle Replacement

Category: Ankle Arthritis Introduction/Purpose: Wound complications after total ankle replacement (TAR) lead to increased postoperative morbidity with lasting consequences. Previous studies demonstrate delayed wound healing in 6.6% to 28% of all TARs. Soft tissue breakdown along the anterior incision can cause exposure of anterior tendons and the implants. In addition, adhesions of the extensor tendons can develop causing significant morbidity. Recent publications advocate for the use of dehydrated human amnion/chorion membrane allograft (dHACM) during closure of anterior ankle incisions during TAR. dHACM is shown to promote increased epithelial cell proliferation, recruitment, and differentiation and reduce the likelihood of tendon adhesions. The goal of this study was to review the use of dHACMs in TARs and to investigate the number and type of postoperative wound complications including extensor tendon adhesions. Methods: We retrospectively reviewed 92 TARs performed between April, 2016 through August, 2018 by two board certified, fellowship trained foot and ankle orthopaedic surgeons. A standard anterior approach was done in all cases. All TARs had dHACM graft placed deep to the tibialis anterior and extensor longus tendon and along the extensor retinaculum prior to final closure of the wound. Upon data review, we identified the subset of patients who had anterior wound dehiscence postoperatively requiring an additional procedure(s) for wound coverage. We compared the demographics, medical comorbidities, and operative characteristics of those with and without perioperative wound complications. Results: 12 patients who underwent TARs sustained wound dehiscence below the subcutaneous tissue and required operative intervention (13%). Of these 12 cases, 5 required bipedical or rotational fasciocutaneous flap coverage (5.4%), 6 required less extensive soft tissue surgery (6.5%) and one case involved a deep periprosthetic infection that resulted in explant and antibiotic spacer placement (1.1%). 6 of the 12 cases required a split thickness skin graft application (6.5%) and 2 cases required tenolysis of extensor tendon adhesions (2.2%). Normal excursion of extensor tendons was seen in 90 patients (97.8%). Except for the one infected ankle, there were no cases with wound dehiscence that communicated with the joint. There were no statistically significant differences in medical comorbidities/operative characteristics between patients with wound complications and those without. Conclusion: Wound complications after total ankle replacements often lead to poor long-term outcomes for patients. Our data suggests that the application of the amniotic membrane allograft and its inherent healing potential decreases postoperative tendon adhesions and significant wound dehiscence. This may lead to less deep wound infections that communicate with the joint and may be protective against total ankle replacement failures due to these complications.

scholarly journals Anterior Incision Offloading for Primary and Revision Total Ankle Replacement: A Comparative Analysis of Two Techniques

2017 ◽  
Vol 11 (1) ◽  
pp. 678-686 ◽  
Author(s):  
Andrew D. Elliott ◽  
Thomas S. Roukis
Keyword(s):  
Wound Healing ◽  
Total Ankle Replacement ◽  
Wound Complications ◽  
Comparison Study ◽  
Delayed Wound Healing ◽  
Replacement Surgery ◽  
Ankle Replacement ◽  
Significant Difference ◽  
Incision Wound ◽  
Anterior Incision

Background: There exists a high risk of post-operative complications with primary and revision total ankle replacement surgery. Delayed wound healing of the anterior incision is common. The reason for this is multi-factorial and, to date, most of the research has focused on predisposing factors involving the patients themselves. Only recently have researchers begun to look at the post-operative dressing as a possible consideration when trying to prevent incision wound healing complications. Currently, no standard post-operative dressing for primary or revision total ankle replacement exists. However, the principles of post-operative edema reduction to improve healing, as advocated by Sir Robert Jones and demonstrated in his compressive dressing, have been known for decades. We have been using a modified Sir Robert Jones compressive dressing for both primary and revision total ankle replacements. Recently, we have added an aperture pad made of cotton cast padding over the anterior incision in order to protect the area from pressure necrosis. Methods: This is a comparison study of the post-operative wound complications involving 35 patients that received the original dressing and 33 patients that received the addition of the aperture pad. Results: With no significant difference in the patient populations, the results demonstrate a 3-fold decrease in the number of anterior incision wound healing complications with the use of the aperture pad. Conclusion: This dressing represents a simple, reproducible, easy to apply and inexpensive way to prevent post-operative edema and anterior incision wound healing complications.

scholarly journals Image Diagnosis in Extensor Tendons Injuries in the Radiocarpal Region in Horses

2020 ◽  
Vol 48 ◽  
Author(s):  
Julie Heide Nunes Paz ◽  
Daniel De Medeiros Assis ◽  
Clédson Calixto de Oliveira ◽  
Rodrigo Barbosa Palmeira ◽  
Bruno Henrique Rodrigues do Nascimento ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Case Reports ◽  
Clinical Signs ◽  
Extensor Tendon ◽  
Tendon Injuries ◽  
Radiographic Examination ◽  
Ultrasound Images ◽  
Presumptive Diagnosis ◽  
Locomotor System ◽  
Extensor Tendons

Background: Soft tissue injuries are common in sport horses, especially those involving tendons, with few current reports in the literature on the diagnosis of extensor injuries, especially with regard to ultrasound characteristics, being essential for the diagnosis of these injuries. The objective of the study is to characterize the clinical signs and the alterations of images, especially ultrasound, in the diagnosis of these lesions of the dorsal radiocarpal region, through case reports of horses seen at the Medical Clinic of Large Animals of the Federal University of Campina Grande (MCLA/UFCG), Patos-PB, Brazil.Cases: The study includes five “vaquejada” competitions horses, of which two were active and the others were away from the sport before the onset of the problem, with injuries to the extensor tendons in the radiocarpal region. Two of the animals had involvement of the common digital extensor muscle tendon (CDEMT), with acute and chronic tenosynovitis, and three with involvement of the extensor carpi radialis muscle tendon (ECRMT), presenting acute tendonitis, septic tenosynovitis and rupture, all of traumatic etiology, except for one whose cause has not been determined. On physical examination, the affected tendon was noticeable in three cases, and two had other injuries associated with the tendons. Bone alteration in the radiographic examination was observed in two cases, however, one of them related to another disease in the radiocarpal palmar region. Ultrasound images, performed in all cases, showed different characteristics and degrees of the involvement of the tendon and its sheath.Discussion: The scarcity of current reports of extensor tendon injuries in horses can be attributed to the fact that they do not suffer as much overload or effect from biomechanics compared to flexor tendons, in addition to being an area of little soft tissue covering these tendons. Although the involvement of the extensor tendons is more frequent in the pelvic limbs, due to lacerations, the occurrence of lesions in the dorsal radiocarpal region may be related to excess flexion, being easily susceptible to trauma to solid objects. The specific clinical examination, associated with a well-explored anamnesis, can allow us to locate the lesion and achieve a presumptive diagnosis. In three cases, tendon injuries were noticeable on inspection and palpation, important points to guide the diagnosis. However, in two cases with associated injuries this perception became difficult. Regardless of the clinical diagnosis, imaging diagnosis in lesions of the locomotor system was essential, as it allowed us to assess bone involvement, accurately determine the location of the lesion, its extent and prognosis, which would not be possible only in the clinic. Through ultrasonography it was possible to classify the lesions into acute (hypoechoic areas) and chronic (hyperechoic areas or with heterogeneous pattern of variable echogenicity), in addition to the thickness and characteristic of the liquid in the tendon sheath, which are also important aspects for lesion classification. Thus, we conclude that the dorsal region at the carpal level is susceptible to trauma and can easily compromise the extensor tendons. And for the diagnosis and adequate conduct, it is necessary to determine ultrasound image regarding the different types of lesions, which is provided in the present study.

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