Noninvasive Skin Expansion Strips to Decrease Wound Issues after Total Ankle Replacement

Abstract

Category: Ankle; Ankle Arthritis; Basic Sciences/Biologics; Other Introduction/Purpose: Total ankle arthroplasty through the anterior approach (TAR-AA) is an increasingly popular treatment for ankle arthritis. This approach carries significant risk for wound complications. Several products have been investigated to mitigate this risk, but these are either costly or invasive. Noninvasive skin expansion strips (NSESs) have two nonelastic adhesive strips, one on either side of the incision, with an elastic band connecting them. These were designed to induce new skin growth at the edges of the strips for plastic surgery applications. In the postoperative setting, the NSES functions to transfer tension away from the site of the incision to the edge of the strips. We hypothesize that postoperative application of NSESs will decrease unplanned clinic visits and wound complications after TAR-AA. Methods: This is a prospective cohort study with retrospectively identified historical controls designed to evaluate the effectiveness of NSESs. Prospectively enrolled patients undergoing TAR-AA at a single institution (3 surgeons) received application of NSESs in the operating room after routine wound closure. At their two-week postoperative visit, each wound was assessed and new NSESs were applied. No other changes were made to the surgeons' wound closure technique, immobilization, follow-up cadence, or rehabilitation protocols. Patients following up with providers outside the institution were excluded. Thirty five consecutive historical controls were identified for comparison. Primary outcomes included (1) Additional clinic visit required for wound assessment or suture removal, (2) superficial wound complication before 8 weeks, and (3) deep infection before 8 weeks. Z-score test was used to calculate statistically significant (p<=0.05) differences between the two groups. Results: To date, 20 patients (62.5 +- 11.8 years; 6 females, 14 males) received application of NSESs. Baseline demographics did not differ significantly from our 35 consecutively identified historical controls (62.2 +- 13.3 years; 16 females, 19 males). Additional clinic visits for suture removal were needed for 15% (3/20) of patients in the treatment group compared to 46% (14/35) of patients in the control group (p=0.021). There were significantly fewer unplanned visits per patient in the treatment group compared to the control group (0.15 vs. 0.54, p=0.004). The superficial wound complication rate in the treatment group vs. control group was 0% and 11%, respectively (p=0.12). There were no deep infections in either group. Conclusion: Noninvasive skin expansion strips are an effective means to improve early wound healing and decrease unplanned clinic visits for wound checks or delayed suture removal after TAR-AA. There was a trend toward significance for NSESs decreasing superficial wound complications. Further high volume studies are needed to clarify their cost effectiveness and effect on deep infections.