Huh Jeannie, Parekh Selene G
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
Foot Ankle Spec. 2016 Feb;9(1):43-7. doi: 10.1177/1938640015598839. Epub 2015 Aug 5.
Despite major improvements in surgical technique and implant designs in total ankle arthroplasty (TAA), wound healing complications are still commonly encountered. Not only do these problems delay postoperative recovery and threaten functional outcomes, they also carry an increased risk of progression to deep wound infection, which can jeopardize ultimate retention of the implant. In an effort to reduce the high frequency of wound-related complications after TAA, we have incorporated the use of continuous external tissue expansion (CETE) to augment our closures of the anterior ankle incision. CETE is an innovative technique that is currently being used to aid in the rapid closure of acute and chronic full thickness soft tissue defects, including fasciotomy wounds, high grade open fractures, and chronic foot ulcers. By exploiting the viscoelastic properties of the skin, this technique not only facilitates wound edge approximation of full thickness defects, it also helps take tension off tenuous incisions, thus allowing them to heal and reducing the chance for wound dehiscence. This is the first description of the use of an external tissue expander for the prevention of wound healing complications in the setting of TAA. Since introducing CETE to the closure of our TAA incisions, we have seen a decrease in the number of postoperative wound complications and time to wound healing. Based on our experience, we believe that the use of CETE for the prophylactic management of tenuous surgical incisions, specifically those used in the anterior approach to the ankle during TAA, is both safe and efficacious.
Level V: Technique tip.
尽管全踝关节置换术（TAA）的手术技术和植入物设计有了重大改进，但伤口愈合并发症仍然常见。这些问题不仅会延迟术后恢复并威胁功能结果，还会增加发展为深部伤口感染的风险，这可能危及植入物的最终保留。为了降低TAA后伤口相关并发症的高发生率，我们采用了连续外部组织扩张（CETE）来加强踝关节前方切口的闭合。CETE是一种创新技术，目前正用于帮助快速闭合急性和慢性全层软组织缺损，包括筋膜切开伤口、高等级开放性骨折和慢性足部溃疡。通过利用皮肤的粘弹性特性，该技术不仅有助于全层缺损的伤口边缘对合，还有助于减轻薄弱切口的张力，从而使其愈合并减少伤口裂开的机会。这是首次描述在TAA中使用外部组织扩张器预防伤口愈合并发症。自从将CETE引入我们的TAA切口闭合以来，我们看到术后伤口并发症的数量和伤口愈合时间有所减少。基于我们的经验，我们认为将CETE用于预防性处理薄弱手术切口，特别是TAA期间踝关节前方入路中使用的切口，是安全有效的。
V级：技术提示。
