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 Angiography

Reference: 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

Reviewed By: Vanessa Cardenas, DPM 

Residency Program: Temple University Hospital, Philadelphia, PA 

Podiatric 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. 

Methods: Thirty 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.
 

Results: 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.

Conclusions: 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.

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