Georgetown University School of Medicine, Washington, DC, USA.
Midlands Orthopaedics and Neurosurgery, Columbia, SC, USA.
Foot Ankle Int. 2020 May;41(5):513-520. doi: 10.1177/1071100720903726. Epub 2020 Feb 10.
Wound complications after total ankle arthroplasty (TAA) are a common postoperative complication occurring in 14% to 66% of all surgeries. Soft tissue breakdown along the anterior incision can cause exposure of anterior tendons and implant, and adhesions of the extensor tendons of the foot. Recent publications have advocated for the implantation of dehydrated human amniotic membrane (DHAM) allograft during closure of anterior ankle incisions during TAA. The goal of this study was to determine whether implantation of DHAM allograft in TAAs decreased overall postoperative wound complications.
One hundred seventy patients with end-stage ankle arthritis refractory to conservative management underwent TAA with a standard anterior approach by 1 of 3 board-certified foot and ankle orthopedic surgeons. Ninety-one patients underwent closure of the anterior incision with addition of DHAM, whereas 79 patients served as the control (no addition of DHAM). The primary endpoints considered were postoperative complications and reoperation. Included in the postoperative complications was return to the operating room, postoperative plastic surgery intervention, wound communication with the implant, removal of the implant, neurolysis, tendon debridement, and extensor hallucis longus contracture/adhesions.
In the analysis of our demographically homogenous cohorts, there was no statistically significant difference in any postoperative complications between patients closed with DHAM and controls. Return to the operating room occurred in 8.9% of controls and 15.4% of the DHAM group ( = .291). Similarly, there was no statistically significant difference in postoperative plastic surgery, wound communication with the implant, implant removal, neurolysis, and tendon debridement between the control and DHAM groups.
The application of DHAM theoretically acts to decrease overall wound complications in TAA. The use of DHAM preceding wound closure in TAA did not show a statistically significant reduction in overall wound complications in our retrospective analysis. Further study, including prospective randomized studies, is needed to further investigate the effectiveness of DHAM in reducing wound complications in TAAs.
Level III, retrospective cohort study.
全踝关节置换术（TAA）后出现伤口并发症是一种常见的术后并发症，在所有手术中发生率为 14%至 66%。前切口处的软组织破裂可导致前肌腱和植入物暴露，并导致足部伸肌腱粘连。最近的出版物主张在 TAA 时在前踝关节切口关闭过程中植入脱水人羊膜（DHAM）同种异体移植物。本研究的目的是确定在 TAA 中植入 DHAM 同种异体移植物是否可以降低总体术后伤口并发症。
170 例晚期踝关节关节炎患者经保守治疗无效，由 3 名具有董事会认证的足踝矫形外科医生中的 1 名采用标准的前入路进行 TAA。91 例患者在前切口关闭时加用 DHAM，79 例患者作为对照组（未加用 DHAM）。主要终点考虑为术后并发症和再次手术。术后并发症包括返回手术室、术后整形手术干预、伤口与植入物相通、取出植入物、神经松解、肌腱清创术和伸肌肌腱 longus 挛缩/粘连。
在我们具有同质人群的分析中，加用 DHAM 和对照组之间在任何术后并发症方面均无统计学差异。对照组中有 8.9%的患者返回手术室，DHAM 组中有 15.4%的患者返回手术室（=0.291）。同样，对照组和 DHAM 组之间在术后整形手术、伤口与植入物相通、植入物取出、神经松解和肌腱清创术方面也无统计学差异。
DHAM 的应用理论上可以降低 TAA 中的整体伤口并发症。在我们的回顾性分析中，在 TAA 中进行伤口闭合之前使用 DHAM 并没有显示出在整体伤口并发症方面的统计学显著降低。需要进一步的研究，包括前瞻性随机研究，以进一步研究 DHAM 在降低 TAA 中伤口并发症方面的有效性。
三级，回顾性队列研究。
