Evaluation of Incisional Negative Pressure Wound Therapy on Anterior Approach Total Ankle Arthroplasty.

Abstract

Total ankle replacement continues to find significantly increased utilization as the technology advances. While there are different systems on the market, most are implanted through an anterior incisional approach just lateral to the tibialis anterior tendon. This incision is prone to decreased wound healing, increased time to healing, and postoperative dehiscence and infection risk. When patient comorbid medical conditions are taken into consideration as well, the chance of complications increases significantly. To date, multiple articles have been published discussing how to decrease complication rate associated with this higher risk incision, such as different suturing patterns, utilization of a postoperative drain, and incisional wound vac application (iNPWT). The purpose of this study is to present our results with iNPWT utilization for anterior approach total ankle arthroplasty. Thirty one (31) patient's consecutive total ankle replacement (TARs) were retrospectively reviewed. Eleven (11) patients underwent TAR with iNPWT (Group 1) application and 20 patients underwent TAR without iNPWT (Group 2) application. In group 1, wound complications were 1/11 (9%) and in group 2 wound complications were 4/20 (20%); with an overall 5/31 (16%) wound complication rate (p value 0.429). In our present study, we identified a reduction of wound healing complications by 11% when comparing the two groups, although failed to reach statistical significance. While future studies are needed with more patient enrollment, iNPWT application is a quick and safe method to help reduce complications associated with the anterior approach for total ankle replacement. Clinical Level of Evidence: 3.