Christopher Bibbo1, David A Ehrlich2, Hoang M L Nguyen2, L Scott Levin3, Stephen J Kovach3. 1. Department of Surgery, Division of Plastic & Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Orthopaedics, Marshfield Clinic, Marshfield, Wisconsin, USA Christopher.bibbo@uphs.upenn.edu bibbo.christopher@marshfieldclinic.org. 2. Department of Surgery, Division of Plastic & Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. 3. Department of Surgery, Division of Plastic & Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Historically, the lateral extensile approach for calcaneal fracture osteosynthesis has had relatively high rates of wound healing problems. The vascular territory (angiosome) of the lateral foot is now known to be dependent upon the lateral calcaneal branch of the peroneal artery (LCBP artery). We postulated that patency of the LCBP artery may have a profound positive impact on incisional wound healing for calcaneal open reduction and internal fixation (ORIF). METHODS: Ninety consecutive calcaneal fractures that met operative criteria were preoperatively evaluated for the presence of a Doppler signal in the LCBP artery and were followed for the development of wound healing problems. RESULTS: Among these 90 fractures, 85 had a positive preoperative Doppler signal along the course of the LCBP artery (94%) and 5 had no Doppler signal (6%). All patients underwent ORIF via a lateral extensile approach. Overall, incisional wound healing problems occurred in 6 of 90 calcaneal incisions (6.5%). All 5 feet that exhibited an absent Doppler signal in the LCPB artery developed an incisional wound healing complication (5/6, approximately 83%): 2 large apical wounds and 3 major dehiscence/slough. However, among the 84 feet that possessed a positive preoperative Doppler signal in the LCBP artery, there was only 1 (1/84, approximately 1%) incisional wound healing problem (P < .0001, Fischer's exact test). Smokers with a positive Doppler signal in the LCBP artery did not develop a wound healing complication. CONCLUSIONS: This study suggests a strong link to low incisional wound healing complications for the lateral extensile approach to the calcaneus when a preoperative Doppler signal is present in the LCBP artery. We believe this simple examination should be routinely performed prior to calcaneal ORIF. LEVEL OF EVIDENCE: Level III, comparative case series.
BACKGROUND: Historically, the lateral extensile approach for calcaneal fracture osteosynthesis has had relatively high rates of wound healing problems. The vascular territory (angiosome) of the lateral foot is now known to be dependent upon the lateral calcaneal branch of the peroneal artery (LCBP artery). We postulated that patency of the LCBP artery may have a profound positive impact on incisional wound healing for calcaneal open reduction and internal fixation (ORIF). METHODS: Ninety consecutive calcaneal fractures that met operative criteria were preoperatively evaluated for the presence of a Doppler signal in the LCBP artery and were followed for the development of wound healing problems. RESULTS: Among these 90 fractures, 85 had a positive preoperative Doppler signal along the course of the LCBP artery (94%) and 5 had no Doppler signal (6%). All patients underwent ORIF via a lateral extensile approach. Overall, incisional wound healing problems occurred in 6 of 90 calcaneal incisions (6.5%). All 5 feet that exhibited an absent Doppler signal in the LCPB artery developed an incisional wound healing complication (5/6, approximately 83%): 2 large apical wounds and 3 major dehiscence/slough. However, among the 84 feet that possessed a positive preoperative Doppler signal in the LCBP artery, there was only 1 (1/84, approximately 1%) incisional wound healing problem (P < .0001, Fischer's exact test). Smokers with a positive Doppler signal in the LCBP artery did not develop a wound healing complication. CONCLUSIONS: This study suggests a strong link to low incisional wound healing complications for the lateral extensile approach to the calcaneus when a preoperative Doppler signal is present in the LCBP artery. We believe this simple examination should be routinely performed prior to calcaneal ORIF. LEVEL OF EVIDENCE: Level III, comparative case series.
Authors: John Bennet Carow; Juliane Carow; Boyko Gueorguiev; Kajetan Klos; Christian Herren; Miguel Pishnamaz; Christian David Weber; Sven Nebelung; Bong-Sung Kim; Matthias Knobe Journal: Int Orthop Date: 2018-06-22 Impact factor: 3.075