Do Closed Suction Drains Affect Postoperative Wound Healing after Total Ankle Arthroplasty?

CATEGORY: Ankle Arthritis; Ankle INTRODUCTION/PURPOSE: Although most studies demonstrate no clear benefit of closed suction drains after total joint arthroplasty of the hip, knee, and shoulder, there is no study that has specifically looked at ankle arthroplasty. Despite the paucity of information regarding the potential benefit or lack thereof with postoperative closed suction drains after total ankle arthroplasty, they are still utilized in practice. The purpose of this study is to determine whether or not the use of closed suction drains after total ankle arthroplasty have an affect on wound complications in the first postoperative year. METHODS: Following a 3:1 match of patients with-drains to those without-drains, 78 patients with-drains and 28 without-drains were included for analysis. The drain group consisted of patients who had drains placed in the immediate postoperative period and removed prior to discharge from the hospital. The without-drains group acted as the control. Demographic data including age, sex, tobacco use, alcohol use, and medical comorbidities (diabetes, bleeding disorders, anemia, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, history of leg ulcers or staphylococcus infection) were obtained. Follow-up data was collected and reviewed at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, for minor and major wound complications, as well as wound-related re-operations. RESULTS: At 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, there was no statistically significant difference in wound complications with or without the use of a drain. Within the first postoperative year, a total of 4 (14.3%) patients with- drains and 24 (30.8%) patients without-drains had a wound complication. This was not statistically significant (p=0.148). The majority of wound complications were minor. A single superficial infection and two reoperations for major wound complications were noted, all of which were in patients who had a drain placed. Age, sex, tobacco use, alcohol use, as well as a history of diabetes, bleeding disorders, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, and history of leg ulcers or staphylococcus infection were similar between both groups. A history of anemia was significantly higher in the drain group, however this was not associated with an increased risk of postoperative wound complications. CONCLUSION: The use of a closed suction drain did not have an effect on postoperative wound complications in the first year after total ankle arthroplasty surgery. Based on the equivocal results in this study and that there is no clear consensus on the use of drains after total ankle arthroplasty surgery, the authors feel it is up to the individual surgeon to determine the necessity of use on a case-by-case basis.