SLR - April 2018 - Vanessa Cardenas
Allgöwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in
Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative
Shannon SF, Houdek MT, Wyles CC, Yuan BJ, Cross WW, Cass JR, Sems SA. Allgöwer-Donati
Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture
Surgery: A Randomized Clinical Trial Using Intraoperative Angiography. Journal of Orthopedic Trauma
. Volume 31,
Number 2, February 2017.
Scientific Literature Review
Residency Program: Temple
University Hospital, Philadelphia, PA
Relevance: Foot and ankle surgeons
encounter ankle fracture pathology in daily practice. There are different
materials and techniques for skin closure. A controversy exists in the
literature in regards to which method of primary closure provides a better chance
for perfusion in areas of tenuous blood flow. This study aims to evaluate which
primary wound closure technique for ankle fractures affords the most robust
perfusion as measured by laser-assisted indocyanine green angiography:
Allgöwer-Donati or vertical mattress.
patients who underwent open reduction internal fixation for ankle fractures
were prospectively randomized to Allgöwer-Donati (n=15) or vertical mattress
(n=15) closure. Demographics were similar for both cohorts when it came to
age, sex, body mass index, surgical timing and OTA/AO fracture classification.
The main outcome measurement of skin perfusion was quantified in fluorescence
units with laser-assisted indocyanine green angiography along the lateral
incision as well as anterior and posterior to the incision at 30 separate
locations. Minimum follow-up was three months with a mean follow-up of 4.7 months.
Allgöwer-Donati sutures enabled superior perfusion compared with 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 with the vertical mattress cohort (23.4, SD=14; P=0.03). One
patient in each cohort experienced a wound complication.
The Allgöwer-Donati suture technique allowed improved incision perfusion when
compared with vertical mattress closure after open reduction internal fixation
of ankle fractures. This may enhance soft-tissue healing and decrease the risk
of wound complications.