Wound Breakdown After Total Ankle Arthroplasty

Background: Wound breakdown of the operative incision is commonly encountered as a complication following ankle replacement surgery. Healing problems can progress to full thickness necrosis of the skin and deeper tissues jeopardizing the ultimate retention of the implants leading to compromised patient outcomes. Materials and Methods: The medical records of 57 consecutive primary total ankle arthroplasties (TAA) were retrospectively reviewed after observing a higher than expected rate of wound-healing problems consistently involving the central third of the operative incision. Results: The rate of wound breakdown was 28% in this series. Analysis of various possible risk factors showed a statistically significant increase in rate of wound breakdown associated with smoking greater than 12 pack years, peripheral vascular disease, and cardiovascular disease. Conclusion: Preoperative identification of patient risk factors associated with breakdown of the operative incision after TAA should improve outcome of the procedure. Screening of those patients with risk factors for wound breakdown is recommended prior to total ankle arthroplasty.