Sidorski Alexandra, Lundeen Gregory
Wound Care, Renown Health, Reno, USA.
Foot and Ankle, Reno Orthopaedic Clinic, Reno, USA.
Cureus. 2020 Jun 13;12(6):e8606. doi: 10.7759/cureus.8606.
Introduction Total ankle arthroplasty (TAA) has become a common procedure in the treatment of end-stage ankle arthritis. Most prostheses utilize an anterior ankle approach, which has been shown to have incisional complication rates of up to 28%, including dehiscence and infection. Wounds in this area can be catastrophic to patient outcomes. Preventing incisional wounds would significantly benefit the patient. The purpose of this study was to evaluate the effect of closed incision negative pressure therapy (ciNPT) in reducing incisional dehiscence and surgical site infection (SSI) after TAA. Materials and methods A retrospective chart review that was approved by the Institutional Review Board (IRB) was performed on patients undergoing TAA. Inclusion criteria were patients undergoing TAA with an anterior incision and ciNPT placed immediately in the operating room. Comorbidities associated with increased wound complications were recorded. Identification of any incisional dehiscence, infections, or deviations from normal postoperative recovery attributed to the former was also recorded. Results Twenty-eight patients met the inclusion criteria. The average age of the patients at the time of surgery was 68 years. Comorbidities associated with compromised healing were obesity (45%), current or former smoking (45%), diabetes (3.5%), and rheumatoid arthritis (7%). There were no postoperative wound complications (100% incisional healing). No patient required any wound-care intervention or had an SSI. None of the patients had any delay in the normal postoperative course. Conclusion Avoiding wound complications in TAA patients is critical to the success of the procedure. This retrospective case series demonstrated 100% healing with the utilization of the ciNPT in both normal and high-risk patients with decreased healing potential. Our results showed a substantial decrease in wound complications and SSIs compared to historical reports. We recommend ciNPT for all TAA procedures utilizing an anterior incision to decrease the risk for wound complications and SSIs.
引言
全踝关节置换术（TAA）已成为治疗终末期踝关节关节炎的常见手术。大多数假体采用踝关节前方入路，研究表明该入路的切口并发症发生率高达28%，包括切口裂开和感染。该区域的伤口可能对患者的预后产生灾难性影响。预防切口伤口将使患者显著受益。本研究的目的是评估闭合切口负压疗法（ciNPT）在降低TAA术后切口裂开和手术部位感染（SSI）方面的效果。
材料与方法
对接受TAA的患者进行了一项经机构审查委员会（IRB）批准的回顾性病历审查。纳入标准为接受TAA且采用前方切口并在手术室立即放置ciNPT的患者。记录与伤口并发症增加相关的合并症。还记录了任何切口裂开、感染或归因于前者的术后恢复异常情况。
结果
28例患者符合纳入标准。患者手术时的平均年龄为68岁。与愈合受损相关的合并症包括肥胖（45%）、当前或既往吸烟（45%）、糖尿病（3.5%）和类风湿关节炎（7%）。无术后伤口并发症（切口愈合率100%）。无患者需要任何伤口护理干预或发生SSI。所有患者术后恢复过程均未延迟。
结论
避免TAA患者出现伤口并发症对手术成功至关重要。本回顾性病例系列表明，在愈合潜力正常和高危的患者中使用ciNPT，愈合率均为100%。与既往报道相比，我们的结果显示伤口并发症和SSI显著减少。我们建议对所有采用前方切口的TAA手术使用ciNPT，以降低伤口并发症和SSI的风险。
