Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intra-operative Angiography.

Steven F. Shannon, Matthew T. Houdek, Cody C. Wyles, Brandon J. Yuan, William W. Cross, Joseph R. Cass, Stephen A. Sems

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE:: The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography (LA-ICGA): Allgöwer-Donati or vertical mattress. DESIGN:: Prospective, randomized. SETTING:: Level 1 Academic Trauma Center.Patients/participants: Thirty patients undergoing open reduction internal fixation (ORIF) for ankle fractures were prospectively randomized to Allgöwer-Donati (n=15) or vertical mattress (n=15) closure. Demographics were similar for both cohorts with respect to age, sex, BMI, surgical timing and AO/OTA fracture classification. MAIN OUTCOME MEASUREMENTS:: Skin perfusion (mean incision perfusion & mean perfusion impairment) was quantified in fluorescence units with LA-ICGA along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow up 4.7 months. RESULTS:: Allgöwer-Donati enabled superior perfusion compared to the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD=13) and for vertical mattress was 28 (SD=10; P<0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD=9) compared to the vertical mattress cohort (23.4, SD=14; P=0.03). One patient in each cohort experienced a wound complication. CONCLUSION:: The Allgöwer-Donati suture technique offers improved incision perfusion compared to vertical mattress closure following ORIF of ankle fractures. Theoretically this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures. LEVEL OF EVIDENCE:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
JournalJournal of Orthopaedic Trauma
DOIs
StateAccepted/In press - Oct 7 2016

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Ankle Fractures
Suture Techniques
Angiography
Randomized Controlled Trials
Perfusion
Indocyanine Green
Wound Closure Techniques
Lasers
Trauma Centers
Wounds and Injuries
Fluorescence
Demography
Skin

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery : A Randomized Clinical Trial Using Intra-operative Angiography. / Shannon, Steven F.; Houdek, Matthew T.; Wyles, Cody C.; Yuan, Brandon J.; Cross, William W.; Cass, Joseph R.; Sems, Stephen A.

In: Journal of Orthopaedic Trauma, 07.10.2016.

Research output: Contribution to journalArticle

Shannon, Steven F. ; Houdek, Matthew T. ; Wyles, Cody C. ; Yuan, Brandon J. ; Cross, William W. ; Cass, Joseph R. ; Sems, Stephen A. / Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery : A Randomized Clinical Trial Using Intra-operative Angiography. In: Journal of Orthopaedic Trauma. 2016.
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abstract = "OBJECTIVE:: The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography (LA-ICGA): Allg{\"o}wer-Donati or vertical mattress. DESIGN:: Prospective, randomized. SETTING:: Level 1 Academic Trauma Center.Patients/participants: Thirty patients undergoing open reduction internal fixation (ORIF) for ankle fractures were prospectively randomized to Allg{\"o}wer-Donati (n=15) or vertical mattress (n=15) closure. Demographics were similar for both cohorts with respect to age, sex, BMI, surgical timing and AO/OTA fracture classification. MAIN OUTCOME MEASUREMENTS:: Skin perfusion (mean incision perfusion & mean perfusion impairment) was quantified in fluorescence units with LA-ICGA along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow up 4.7 months. RESULTS:: Allg{\"o}wer-Donati enabled superior perfusion compared to the vertical mattress suture technique. Mean incision perfusion for Allg{\"o}wer-Donati was 51 (SD=13) and for vertical mattress was 28 (SD=10; P<0.0001). Mean perfusion impairment was less in the Allg{\"o}wer-Donati cohort (12.8, SD=9) compared to the vertical mattress cohort (23.4, SD=14; P=0.03). One patient in each cohort experienced a wound complication. CONCLUSION:: The Allg{\"o}wer-Donati suture technique offers improved incision perfusion compared to vertical mattress closure following ORIF of ankle fractures. Theoretically this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures. LEVEL OF EVIDENCE:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.",
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AU - Shannon, Steven F.

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AU - Wyles, Cody C.

AU - Yuan, Brandon J.

AU - Cross, William W.

AU - Cass, Joseph R.

AU - Sems, Stephen A.

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N2 - OBJECTIVE:: The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography (LA-ICGA): Allgöwer-Donati or vertical mattress. DESIGN:: Prospective, randomized. SETTING:: Level 1 Academic Trauma Center.Patients/participants: Thirty patients undergoing open reduction internal fixation (ORIF) for ankle fractures were prospectively randomized to Allgöwer-Donati (n=15) or vertical mattress (n=15) closure. Demographics were similar for both cohorts with respect to age, sex, BMI, surgical timing and AO/OTA fracture classification. MAIN OUTCOME MEASUREMENTS:: Skin perfusion (mean incision perfusion & mean perfusion impairment) was quantified in fluorescence units with LA-ICGA along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow up 4.7 months. RESULTS:: Allgöwer-Donati enabled superior perfusion compared to the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD=13) and for vertical mattress was 28 (SD=10; P<0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD=9) compared to the vertical mattress cohort (23.4, SD=14; P=0.03). One patient in each cohort experienced a wound complication. CONCLUSION:: The Allgöwer-Donati suture technique offers improved incision perfusion compared to vertical mattress closure following ORIF of ankle fractures. Theoretically this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures. LEVEL OF EVIDENCE:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

AB - OBJECTIVE:: The purpose of this study was to evaluate which primary wound closure technique for ankle fractures affords the most robust perfusion as measured by laser-assisted indocyanine green angiography (LA-ICGA): Allgöwer-Donati or vertical mattress. DESIGN:: Prospective, randomized. SETTING:: Level 1 Academic Trauma Center.Patients/participants: Thirty patients undergoing open reduction internal fixation (ORIF) for ankle fractures were prospectively randomized to Allgöwer-Donati (n=15) or vertical mattress (n=15) closure. Demographics were similar for both cohorts with respect to age, sex, BMI, surgical timing and AO/OTA fracture classification. MAIN OUTCOME MEASUREMENTS:: Skin perfusion (mean incision perfusion & mean perfusion impairment) was quantified in fluorescence units with LA-ICGA along the lateral incision as well as anterior and posterior to the incision at 30 separate locations. Minimum follow-up was 3 months with a mean follow up 4.7 months. RESULTS:: Allgöwer-Donati enabled superior perfusion compared to the vertical mattress suture technique. Mean incision perfusion for Allgöwer-Donati was 51 (SD=13) and for vertical mattress was 28 (SD=10; P<0.0001). Mean perfusion impairment was less in the Allgöwer-Donati cohort (12.8, SD=9) compared to the vertical mattress cohort (23.4, SD=14; P=0.03). One patient in each cohort experienced a wound complication. CONCLUSION:: The Allgöwer-Donati suture technique offers improved incision perfusion compared to vertical mattress closure following ORIF of ankle fractures. Theoretically this may enhance soft tissue healing and decrease the risk of wound complications. Surgeons may take this into consideration when deciding closure techniques for ankle fractures. LEVEL OF EVIDENCE:: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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