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Anteromedial Approach for Total Ankle Arthroplasty

March 01, 2020

Contributors: Shahin Kayum, MD; Lucy Kerjikian; Ryan Khan; Timothy Rudolf Daniels, MD, FRCSC

2020 AWARD WINNER Introduction Despite major improvements in surgical techniques and implant designs for total ankle arthroplasty, wound healing complications are common. The classic anterior approach for total ankle arthroplasty is associated with a high rate of wound healing complications. High complication rates result from poor tissue handling by surgeons and poor patient selection. An angiosome-based approach involves making the incision between two angiosomes for ideal wound healing. Method The medical charts of 50 patients who underwent total ankle arthroplasty between January 2019 and June 2019 were reviewed. An anteromedial approach was used in 20 patients. These patients' medical charts were evaluated for wound healing complications, age, and comorbidities. Results An anteromedial approach was used in 20 patients. All patients had at least one postoperative visit. At the first postoperative visit, no evidence of infection was observed in any of the patients, and no complications were noted during any subsequent postoperative visits. Conclusion The anteromedial approach is an angiosome-based approach for total ankle arthroplasty and is associated with a low rate of wound healing complications. This is a good approach for patients with a poor tissue envelope from previous surgery or injury and patients with comorbidities, such as diabetes mellitus and inflammatory pathology.

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