Oxygen tensiometry as a predictor of wound healing in total ankle arthroplasty

Objectives: Total ankle arthroplasty (TAA) typically in¬volves an anterior approach to the ankle that has been shown to have a risk for wound healing problems. We explored the possibility of using oxygen tensiometry as a predictor of in¬cision healing problems in patients undergoing TAA. Methods: The study included 25 patients who underwent TAA with the Scandinavian Total Ankle Replacement (STAR) sys¬tem at our institution during a three-year period. Transcutane- ous oxygen measurements of both ankles were obtained post- operatively to determine whether the results of transcutaneous oxygen tensiometry correlated with wound healing problems. Patients with wound healing problems were compared with those who had an uneventful incision healing. Results: Seven patients (28%) had wound healing problems after TAA, and five patients (20%) had early wound erythe¬ma. Wound healing problems included delayed healing in five patients and dehiscence in two patients. Three patients had transcutaneous oxygen tension of less than 40 mmHg (a threshold for impaired skin oxygenation) on the opera¬tive side, of whom one had healing difficulty whereas two did not. When the threshold was extended to 50 mmHg, seven patients (28%) had low readings, two having wound healing problems. There was no significant difference with respect to oxygen measurements between patients with and without wound healing problems (p=0.3). Conclusion: Oxygen tensiometry is not thought to be use¬ful for predicting patients at risk for postoperative wound healing complications after TAA, suggesting that, if ade¬quate pulses are present before surgery, the trauma of using excessive superficial traction on the skin during surgery is more responsible for wound healing problems than the un¬derlying blood supply.