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Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage
CATEGORY: Ankle Arthritis; Ankle; Diabetes INTRODUCTION/PURPOSE: Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patie...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697100/ http://dx.doi.org/10.1177/2473011420S00032 |
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author | Cunningham, Daniel J. Ryan, Sean Adams, Samuel B. |
author_facet | Cunningham, Daniel J. Ryan, Sean Adams, Samuel B. |
author_sort | Cunningham, Daniel J. |
collection | PubMed |
description | CATEGORY: Ankle Arthritis; Ankle; Diabetes INTRODUCTION/PURPOSE: Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patient morbidity, particularly when they require return to the operating room and flap coverage. We sought to determine the risk factors associated with the need for flap coverage over TAA, and hypothesized that intraoperative variables such as additional procedures to provide angular correction would play a more important role than patient-specific variables. METHODS: We performed a single center retrospective review of primary total ankle arthroplasties from April 2007 - February 2019. Patients demographics and medical comorbidities were collected in addition to concomitant procedures performed at the time of TAA such as tibial osteotomies, removal of hardware, and subtalar fusion. Multivariable, main effects logistic regression models were performed to evaluate the impact of specific concomitant procedures during primary TAA on the rate of subsequent flap coverage with adjustment for age, sex, and medical comorbidities. RESULTS: 2,124 TAA resulted in 29 flaps after an average of 1.1 (range 0-5) surgeries and 89.7 (range 18-591) days after the index arthroplasty. The most common flap was a radial forearm free flap performed in 15 (51.7%) patients. Patients requiring flap coverage were significantly older (p=0.044), were more likely to be diabetic (p=0.029), and were more likely to present to the ED and be readmitted within 90-days of their surgery (p<0.001). In a multivariable model controlling for age, gender, and diabetes diagnosis, patients with flaps were more likely to have a concomitant osteotomy (OR 3.720, 95% CI 1.693-8.177; p=0.001) at the time of there TAA. Other concomitant procedures did not show a significant association with subsequent need for flap coverage. CONCLUSION: Simultaneous procedures during TAA may place patients at higher risk of wound breakdown, specifically requiring flap coverage. In particular, osteotomies, namely tibial osteotomies for realignment, carry a special risk for wound healing difficulty. This should be considered as the indications for TAA continue to expand. |
format | Online Article Text |
id | pubmed-8697100 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-86971002022-01-28 Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage Cunningham, Daniel J. Ryan, Sean Adams, Samuel B. Foot Ankle Orthop Article CATEGORY: Ankle Arthritis; Ankle; Diabetes INTRODUCTION/PURPOSE: Total ankle arthroplasty (TAA) results in improved patient outcomes and preserved range of motion for patients with end-stage arthritis. Wound complications following these procedures, while rare, can have a significant impact on patient morbidity, particularly when they require return to the operating room and flap coverage. We sought to determine the risk factors associated with the need for flap coverage over TAA, and hypothesized that intraoperative variables such as additional procedures to provide angular correction would play a more important role than patient-specific variables. METHODS: We performed a single center retrospective review of primary total ankle arthroplasties from April 2007 - February 2019. Patients demographics and medical comorbidities were collected in addition to concomitant procedures performed at the time of TAA such as tibial osteotomies, removal of hardware, and subtalar fusion. Multivariable, main effects logistic regression models were performed to evaluate the impact of specific concomitant procedures during primary TAA on the rate of subsequent flap coverage with adjustment for age, sex, and medical comorbidities. RESULTS: 2,124 TAA resulted in 29 flaps after an average of 1.1 (range 0-5) surgeries and 89.7 (range 18-591) days after the index arthroplasty. The most common flap was a radial forearm free flap performed in 15 (51.7%) patients. Patients requiring flap coverage were significantly older (p=0.044), were more likely to be diabetic (p=0.029), and were more likely to present to the ED and be readmitted within 90-days of their surgery (p<0.001). In a multivariable model controlling for age, gender, and diabetes diagnosis, patients with flaps were more likely to have a concomitant osteotomy (OR 3.720, 95% CI 1.693-8.177; p=0.001) at the time of there TAA. Other concomitant procedures did not show a significant association with subsequent need for flap coverage. CONCLUSION: Simultaneous procedures during TAA may place patients at higher risk of wound breakdown, specifically requiring flap coverage. In particular, osteotomies, namely tibial osteotomies for realignment, carry a special risk for wound healing difficulty. This should be considered as the indications for TAA continue to expand. SAGE Publications 2020-11-06 /pmc/articles/PMC8697100/ http://dx.doi.org/10.1177/2473011420S00032 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Cunningham, Daniel J. Ryan, Sean Adams, Samuel B. Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage |
title | Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage |
title_full | Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage |
title_fullStr | Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage |
title_full_unstemmed | Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage |
title_short | Total Ankle Arthroplasty: Risk Factors For Subsequent Flap Coverage |
title_sort | total ankle arthroplasty: risk factors for subsequent flap coverage |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8697100/ http://dx.doi.org/10.1177/2473011420S00032 |
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